| Doctor Name: | ANDREA A BONANNO |
| NPI Number: | 1235305061 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0024164854 |
| Business Practice Address: | 9409b Old Burke Lake Rd Burke, VA - 220153127 |
| Business Phone Number: | 7039784200 |
| Business Fax Number: | |
| Mailing Address: | 9409b Old Burke Lake Rd, BURKE |
| State: | VA |
| Postal Code: | 220153127 |
| Phone Number: | 7039784200 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2008 |
| NPI Last Update Date: | 05/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024164854 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |