Provider Demographics
NPI:1558783480
Name:WILMORE, JONNE L (NP-C, CPNP-AC)
Entity Type:Individual
Prefix:
First Name:JONNE
Middle Name:L
Last Name:WILMORE
Suffix:
Gender:F
Credentials:NP-C, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4135
Mailing Address - Fax:319-353-8597
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4135
Practice Address - Fax:319-353-8597
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX780307363LF0000X
TXAP125107363LF0000X
IAC177426363LP0222X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333201707Medicaid
TX333201708OtherMEDICAID-CSHCN
TX8KL972OtherBCBS