Individual
JYL L WONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
640 S 19TH ST STE 100, NEVADA, IA 50201
(515) 382-5413
(515) 382-7107
Mailing address
640 S 19TH ST STE 100, NEVADA, IA 50201-2902
(155) 382-5413
(155) 382-7107
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001551
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098863
HEALTH ALLIANCE
—
01
—
5100837
CONTROLLED SUBSTANCE #
IA
01
—
93389
IA BCBS SEEN IN RI
IA
01
—
Q23957
UPIN
—
Enumeration date
09/20/2005
Last updated
03/07/2023
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