Provider Demographics
NPI:1598848426
Name:GAB, NONA A (CRNA)
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:A
Last Name:GAB
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38406 129TH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-8386
Mailing Address - Country:US
Mailing Address - Phone:605-229-7361
Mailing Address - Fax:605-622-5255
Practice Address - Street 1:305 S STATE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4527
Practice Address - Country:US
Practice Address - Phone:605-622-5000
Practice Address - Fax:605-622-5255
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR019281367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0005144OtherBLUECROSS
SD5800030Medicaid
SD430033903OtherTRAVLERS MEDICARE
SDR46322OtherDAKOTACARE - COMMERCIAL I
SD0005144OtherBLUECROSS
SD430033903OtherTRAVLERS MEDICARE