Healthcare Provider Details

I. General information

NPI: 1871483800
Provider Name (Legal Business Name): LAUREN NICOLE GONNERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN NICOLE GONNERMAN ARNP

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLD HYW 5
CENTERVILLE IA
52544
US

IV. Provider business mailing address

20709 520TH ST
CENTERVILLE IA
52544-8600
US

V. Phone/Fax

Practice location:
  • Phone: 641-437-4111
  • Fax:
Mailing address:
  • Phone: 515-782-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF09260613
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number169140
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: