Gloria Elaine Deones, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10877 Issued in MN

Practice address

715 E 78TH St
Bloomington, MN 55420-1397

Phone

(612) 873-7644

Fax

(952) 854-1272

NPI assigned

Jun 18, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327276800000",
    "number": "1174728331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE # G2",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-4401",
            "fax_number": "612-904-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E 78TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554201397",
            "telephone_number": "612-873-7644",
            "fax_number": "952-854-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEONES",
        "first_name": "GLORIA",
        "middle_name": "ELAINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-18",
        "last_updated": "2012-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01220",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005952",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.