Basic Information
Provider Information
NPI: 1003806571
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BONDLOW
FirstName: LAURA
MiddleName: A
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BREWER
OtherFirstName: LAURA
OtherMiddleName: A
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PAC
OtherLastNameType: 1
Mailing Information
Address1: 75 WASHINGTON ST
Address2:  
City: NORWELL
State: MA
PostalCode: 020611795
CountryCode: US
TelephoneNumber: 7818785200
FaxNumber: 7818783989
Practice Location
Address1: 75 WASHINGTON ST
Address2:  
City: NORWELL
State: MA
PostalCode: 020611795
CountryCode: US
TelephoneNumber: 7818785200
FaxNumber: 7818783989
Other Information
ProviderEnumerationDate: 10/26/2005
LastUpdateDate: 12/28/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X1446MAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
9207801MAFALLONOTHER
04229784501MATRICAREOTHER
04229784501 PHCS/MULTI-PLANOTHER
04229784501MADOC FIRSTOTHER
04229784501MAGREAT WEST HEALTH CAREOTHER


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