Basic Information
| Provider Information | |||||||||
| NPI: | 1104919745 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BOND | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | L. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY RD, #7440 | ||||||||
| Address2: | COMMANDER, USA-MEDDAC-AK, ATTN:MCUC-MMD-QM | ||||||||
| City: | FT. WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534847 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY RD, #7440 | ||||||||
| Address2: | COMMANDER, USA-MEDDAC-AK, ATTN:MCUC-MMD-QM | ||||||||
| City: | FT. WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 169254 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 853 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.