| Doctor Name: | AUTUMN M BONDESEN |
| NPI Number: | 1063749414 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 055-0031000 |
| Business Practice Address: | 44 Main St Suite 200 Richford, VT - 054761153 |
| Business Phone Number: | 8022555500 |
| Business Fax Number: | 8022555589 |
| Mailing Address: | 6 Ouellet Drive, ST ALBANS |
| State: | VT |
| Postal Code: | 05478 |
| Phone Number: | 8025784979 |
| Fax Number: | 8022555589 |
| NPI Enumeration Date: | 11/05/2009 |
| NPI Last Update Date: | 09/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 055-0031000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |