Provider Demographics
NPI:1003863176
Name:BARTOS, BONNIE J (PA-C)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:BARTOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 JEFFERSON ST NORTH
Mailing Address - Street 2:TRI-COUNTY HOSPITAL
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1296
Mailing Address - Country:US
Mailing Address - Phone:218-631-3510
Mailing Address - Fax:218-631-7507
Practice Address - Street 1:415 JEFFERSON ST NORTH
Practice Address - Street 2:TRI-COUNTY HEALTH CARE
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1296
Practice Address - Country:US
Practice Address - Phone:218-631-3510
Practice Address - Fax:218-631-7507
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9126363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN199583900Medicaid
MN199583900Medicaid
MN080004980Medicare ID - Type Unspecified