Provider Demographics
NPI:1396418281
Name:VONDERHAAR, MARIA LOUANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LOUANN
Last Name:VONDERHAAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W US HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-1793
Mailing Address - Country:US
Mailing Address - Phone:319-316-3096
Mailing Address - Fax:
Practice Address - Street 1:1200 W US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-1793
Practice Address - Country:US
Practice Address - Phone:630-599-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty