Individual
GAIL M BONN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1309 10TH AVE W, MOBRIDGE, SD 57601-1146
(605) 845-3692
(605) 845-8252
Mailing address
1309 10TH AVE W, MOBRIDGE, SD 57601-1146
(605) 845-3692
(605) 845-8252
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0390
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497788939
NPI
—
05
—
1497788939
—
SD
05
—
6826040
—
SD
01
—
S103976
PTAN
—
Enumeration date
07/08/2006
Last updated
11/17/2015
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