Healthcare Provider Details

I. General information

NPI: 1598848426
Provider Name (Legal Business Name): NONA A GAB CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S STATE ST
ABERDEEN SD
57401-4527
US

IV. Provider business mailing address

38406 129TH ST
ABERDEEN SD
57401-8386
US

V. Phone/Fax

Practice location:
  • Phone: 605-622-5000
  • Fax: 605-622-5255
Mailing address:
  • Phone: 605-229-7361
  • Fax: 605-622-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR019281
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: