Provider Demographics
NPI:1689978603
Name:VANNICE, ANN M (APN)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:VANNICE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11333 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7908
Mailing Address - Country:US
Mailing Address - Phone:515-557-3100
Mailing Address - Fax:515-557-3249
Practice Address - Street 1:11333 AURORA AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7908
Practice Address - Country:US
Practice Address - Phone:515-557-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ136375363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1072Medicare PIN