WENDELL R BONNER (NPI# 1033140660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033140660 |
| Entity Type | Individual |
| Full Name | WENDELL R BONNER |
| Credential | MD |
| Practice Address |
4212 Grand Ave Duluth MN 55807 |
| Mailing Address |
4212 Grand Avenue Duluth MN 55807 |
| Practice Telephone | 2187863500 |
| Mailing Telephone | 2187863500 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2011-05-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 38966 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 380838600 | 05 |
| Street Address |
4212 GRAND AVE |
| City | DULUTH |
| State | MN |
| Zip Code | 55807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205882594 | Adam Charles Swank | Family Medicine | 4212 Grand Ave, Essentia Health West Duluth Clinic, Duluth, MN 55807-2737 | 2006-05-26 |
| 1134743586 | Erika K Ehlers | Registered Nurse | 4212 Grand Ave, Duluth, MN 55807-2737 | 2020-06-02 |
| 1457991804 | Matt Kleven | Physician Assistant | 4212 Grand Ave, Duluth, MN 55807-2737 | 2020-01-14 |
| 1588204044 | Matthew G Schull | Physician Assistant | 4212 Grand Ave, Duluth, MN 55807-2737 | 2020-01-13 |
| 1124675566 | Amos Restad | Nurse Practitioner | 4212 Grand Ave, Duluth, MN 55807-2737 | 2019-08-21 |
| 1164089702 | Sarah M Jackson | Physical Therapist | 4212 Grand Ave, Duluth, MN 55807-2737 | 2019-05-20 |
| 1023578515 | Megan Elizabeth Markes | Physician Assistant | 4212 Grand Ave, Duluth, MN 55807-2737 | 2019-03-21 |
| 1134685035 | Anthony C Guidone | Nurse Practitioner | 4212 Grand Ave, Duluth, MN 55807-2737 | 2019-02-15 |
| 1679051791 | Brianna N Buske | Physical Therapist | 4212 Grand Ave, Duluth, MN 55807-2737 | 2018-07-31 |
| 1174075246 | Lucette Vankessel | Nurse Practitioner | 4212 Grand Ave, Essentia Health West Duluth Clinic, Duluth, MN 55807-2737 | 2016-10-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568918126 | Jaime Lynn Mallory | Counselor | 4000 W 9th St., Duluth, MN 55807 | 2016-09-01 |
| 1568817138 | Fathers Rise Together | Community/Behavioral Health | 319 N 22nd Ave West, Duluth, MN 55807 | 2016-05-02 |
| 1558660357 | Melissa June Huray | Counselor | 326 North Central Avenue, Duluth, MN 55807 | 2011-03-18 |
| 1376757682 | Chiropractic Health Center P A | Chiropractor | 215 North Central Ave, Duluth, MN 55807 | 2007-05-09 |
| 1639235914 | Mark Andrew Nelson Albee | Social Worker | 4214 Grand Avenue, Duluth Clinic-west, Duluth, MN 55807 | 2006-12-29 |
| 1851457758 | Northwood Children's Services, Inc. | Counselor | 4000 W 9th St, Duluth, MN 55807 | 2006-12-28 |
| 1679934012 | Rebecca Ann Peterson | Nurse Practitioner | 4325 Grand Ave, Duluth, MN 55807 | 2016-03-13 |
| 1225525645 | Mark J Engebretson | Social Worker | 5814 Elinor St, Duluth, MN 55807-1215 | 2018-04-20 |
| 1235756784 | Allissa Rardin | Social Worker | 720 N Central Ave, Duluth, MN 55807-1305 | 2020-07-01 |
| 1588898829 | Angela Sue Rosas | Registered Nurse | 618 1/2 N 56th Ave W, Duluth, MN 55807-1325 | 2009-05-14 |
| Find all providers in zip 55807 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811553084 | Clement Ayanbadejo LLC | Family Medicine | 2282 Meadow Church Rd Ste 200, Duluth, GA 30097-5318 | 2019-05-14 |
| 1902391923 | Young-tae Kim | Family Medicine | 3610 Peachtree Industrial Blvd Ste 100, Duluth, GA 30096-5139 | 2018-06-22 |
| 1659655538 | Primary Care of Atlanta | Family Medicine | 4124 Chattahoochee Trce, Ste 103, Duluth, GA 30097-2147 | 2011-10-10 |
| 1639462997 | James F Conniff | Family Medicine | Duluth Family Medicine Clinic, 330 N Eighth Ave E, Duluth, MN 55805 | 2011-05-19 |
| 1497087126 | St. Luke's Hospital of Duluth | Family Medicine | 6351 E. Superior St., Duluth, MN 55804-2545 | 2010-02-05 |
| 1861729816 | Mark Steven Grimsley | Family Medicine | 1611 Satellite Blvd Ste 3, Duluth, GA 30097 | 2009-11-12 |
| 1154552990 | Clement O Ayanbadejo | Family Medicine | 2282 Meadow Church Rd, Ste 200, Duluth, GA 30097-5318 | 2009-07-28 |
| 1891950457 | Liem Chi Ngo | Family Medicine | 4470 Satellite Blvd, Suite 204, Duluth, GA 30096-8851 | 2008-07-23 |
| 1962663302 | Martin Charles Hinz | Family Medicine | 1150 88th Ave W, Duluth, MN 55808-1505 | 2008-06-18 |
| 1447422506 | Onelio Emilio Perdomo | Family Medicine | 3750 Venture Drive, Suite 130, Duluth, GA 30096-1808 | 2008-03-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.