| Olivia Bonanno, CNP | |
|
900 Commonwealth Pl, Virginia Beach, VA 23464-4517 | |
| (252) 621-2453 | |
| Not Available |
| Full Name | Olivia Bonanno |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 900 Commonwealth Pl, Virginia Beach, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720564735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 0024179720 (Virginia) | Primary |
| Entity Name | South Bay Mental Health Center, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023096864 PECOS PAC ID: 5395797310 Enrollment ID: O20050217000395 |
| Entity Name | Sb Transitional Sub Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962091173 PECOS PAC ID: 7911315379 Enrollment ID: O20210423000601 |
| Mailing Address | Practice Location Address |
|---|---|
| Olivia Bonanno, CNP 900 Commonwealth Pl, Virginia Beach, VA 23464-4517 Ph: (252) 621-2453 | Olivia Bonanno, CNP 900 Commonwealth Pl, Virginia Beach, VA 23464-4517 Ph: (252) 621-2453 |
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