Provider Demographics
NPI:1629410642
Name:GONNERMAN, ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GONNERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:OLTROGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9400
Mailing Address - Fax:515-643-9405
Practice Address - Street 1:6601 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-6138
Practice Address - Country:US
Practice Address - Phone:515-643-9400
Practice Address - Fax:515-643-9405
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA117061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily