Provider Demographics
NPI:1497159743
Name:BONN, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BONN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:NISHIYAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 385138
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-0138
Mailing Address - Country:US
Mailing Address - Phone:808-896-7380
Mailing Address - Fax:
Practice Address - Street 1:68-3879 HOLOIMUA PLACE
Practice Address - Street 2:
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-0138
Practice Address - Country:US
Practice Address - Phone:808-896-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health