Provider Demographics
NPI:1780055780
Name:BONTE, LACEY (DNP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:BONTE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-2145
Mailing Address - Country:US
Mailing Address - Phone:605-770-7577
Mailing Address - Fax:
Practice Address - Street 1:1900 GRASSLAND DR
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-6205
Practice Address - Country:US
Practice Address - Phone:605-996-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDF1015269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily