Provider Demographics
NPI:1871673608
Name:GIACCHETTI, BONNIE J (PAC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:GIACCHETTI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 GALISTEO ST STE N9A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2111
Mailing Address - Country:US
Mailing Address - Phone:505-820-1482
Mailing Address - Fax:505-982-0696
Practice Address - Street 1:2019 GALISTEO ST STE N9A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2111
Practice Address - Country:US
Practice Address - Phone:505-820-1482
Practice Address - Fax:505-982-0696
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-PA15363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical