Provider Demographics
NPI:1396821096
Name:WHANNEL, MARIE ANTOINETTE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:WHANNEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAER
Mailing Address - State:IA
Mailing Address - Zip Code:50675-1304
Mailing Address - Country:US
Mailing Address - Phone:319-478-8947
Mailing Address - Fax:319-478-2025
Practice Address - Street 1:412 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2947
Practice Address - Country:US
Practice Address - Phone:641-753-4021
Practice Address - Fax:641-753-4025
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC044554363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1222513Medicaid