Individual
AUTUMN M BONDESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
44 MAIN ST, SUITE 200, RICHFORD, VT 05476-1153
(802) 255-5500
(802) 255-5589
Mailing address
6 OUELLET DRIVE, ST ALBANS, VT 05478
(802) 578-4979
(802) 255-5589
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055-0031000
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000445
—
VT
Enumeration date
11/05/2009
Last updated
09/25/2012
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