Provider Demographics
NPI:1720157928
Name:VONBANK, JENNIFER LYNN (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:VONBANK
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 1:122 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:IA
Mailing Address - Zip Code:50517-8078
Mailing Address - Country:US
Mailing Address - Phone:515-885-2336
Mailing Address - Fax:515-885-2639
Practice Address - Street 1:122 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:IA
Practice Address - Zip Code:50517-8078
Practice Address - Country:US
Practice Address - Phone:515-885-2336
Practice Address - Fax:515-885-2639
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001470363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36897OtherWELLMARK
IA36898OtherWELLMARK
IAP65485Medicare UPIN