Individual
HEIDI M BONTHUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA--C
Contact information
Practice address
905 FRANKLIN ST, WATERLOO, IA 50703-4407
(319) 272-4300
Mailing address
905 FRANKLIN ST, WATERLOO, IA 50703-4407
(319) 874-3000
(319) 874-3411
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000826
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076372
—
IA
05
—
0184473
—
IA
01
—
IA0133
JOHN DEERE HEALTH CARE
—
Enumeration date
07/14/2005
Last updated
04/30/2018
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