Provider Demographics
NPI:1457672743
Name:VARNER, ANNE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:VARNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE A100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4330
Mailing Address - Fax:515-241-4363
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE A100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4330
Practice Address - Fax:515-241-4363
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003756363A00000X
IA002115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002115OtherSTATE LICENSE
IL085003756OtherSTATE LICENSE
IL420340008Medicare PIN
IA408010012Medicare PIN