Individual
GLORIA ELAINE DEONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
715 E 78TH ST, BLOOMINGTON, MN 55420-1397
(612) 873-7644
(952) 854-1272
Mailing address
701 PARK AVE # G2, MINNEAPOLIS, MN 55415-1623
(612) 873-4401
(612) 904-4401
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10877
MN
363A00000X
Physician Assistant
PA01220
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005952
—
OR
Enumeration date
06/18/2007
Last updated
01/23/2012
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