Provider Demographics
NPI:1023172590
Name:CLAYTON, BONITA R (CRNP)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:R
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 LOCUST AVENUE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2735
Mailing Address - Country:US
Mailing Address - Phone:724-906-4798
Mailing Address - Fax:724-918-9068
Practice Address - Street 1:741 LOCUST AVENUE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2735
Practice Address - Country:US
Practice Address - Phone:724-906-4798
Practice Address - Fax:724-918-9068
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN257093L363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34015Medicare UPIN