NPI 1801514658 · live from the CMS NPI Registry
Landyn Paige Bonamico
Physician Assistant in Bridgeport, WV. National Provider Identifier 1801514658, active.
NPI record
| NPI | 1801514658 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 1370 Johnson Ave, Bridgeport, WV 26330 |
| Practice phone | 304-842-3330 |
| Enumerated | August 18, 2022 |
| Last updated | July 1, 2024 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Physician Assistant primary | 363A00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.