Provider Demographics
NPI:1851378533
Name:WONNELL, DAVID L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:WONNELL
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 VALLEY WEST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3902
Mailing Address - Country:US
Mailing Address - Phone:515-223-4368
Mailing Address - Fax:515-453-2368
Practice Address - Street 1:105 VALLEY WEST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3902
Practice Address - Country:US
Practice Address - Phone:515-223-4368
Practice Address - Fax:515-453-2368
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA001548363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2609Medicare PIN
IAQ10478Medicare UPIN