Provider Demographics
NPI:1427575489
Name:BONNER, ALEXANDRIA J (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:J
Last Name:BONNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:J
Other - Last Name:BUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:223 S WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6974
Mailing Address - Country:US
Mailing Address - Phone:515-368-7504
Mailing Address - Fax:515-355-3491
Practice Address - Street 1:223 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6974
Practice Address - Country:US
Practice Address - Phone:515-368-7504
Practice Address - Fax:515-355-3491
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant