Provider Demographics
NPI:1285885715
Name:NOORDSY, GAEA LINN BOSSMAN (PA-C)
Entity type:Individual
Prefix:
First Name:GAEA LINN
Middle Name:BOSSMAN
Last Name:NOORDSY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GAEA
Other - Middle Name:LINN
Other - Last Name:BOSSMAN NOORDSY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6548
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-6688
Practice Address - Fax:605-333-1578
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant