Provider Demographics
NPI:1699187831
Name:MAAS, JONNA ANN (MD)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:ANN
Last Name:MAAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE STREET SE PHILLIPS WANGENSTEEN BUILDING
Mailing Address - Street 2:14TH FLOOR, SUITE 100B
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-0990
Mailing Address - Fax:612-625-3238
Practice Address - Street 1:300 S BRUCE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1934
Practice Address - Country:US
Practice Address - Phone:507-532-9661
Practice Address - Fax:507-537-9053
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2018-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN61915208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1699187831Medicaid