Healthcare Provider Details
I. General information
NPI: 1497799068
Provider Name (Legal Business Name): VINNETTE FRANK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1316 S MAIN ST
CLARION IA
50525-2019
US
IV. Provider business mailing address
2851 HIGHWAY 3
ROWAN IA
50470-7515
US
V. Phone/Fax
- Phone: 515-532-2811
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363AM0700X |
| Taxonomy | Medical Physician Assistant |
| License Number | 001458 |
| License Number State | IA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 33444 |
| Identifier Type | OTHER |
| Identifier State | IA |
| Identifier Issuer | FPC BCBS NRH |
| # 2 | |
| Identifier | 36174 |
| Identifier Type | OTHER |
| Identifier State | IA |
| Identifier Issuer | BCBS DME |
| # 3 | |
| Identifier | 0424507 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 4 | |
| Identifier | 0600460 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 5 | |
| Identifier | 0293522 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 6 | |
| Identifier | 0655001 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 7 | |
| Identifier | 0283465 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 8 | |
| Identifier | 29352 |
| Identifier Type | OTHER |
| Identifier State | IA |
| Identifier Issuer | BCBS ER |
| # 9 | |
| Identifier | 66046 |
| Identifier Type | OTHER |
| Identifier State | IA |
| Identifier Issuer | BCBS SNF |
| # 10 | |
| Identifier | 0635011 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 11 | |
| Identifier | 60046 |
| Identifier Type | OTHER |
| Identifier State | IA |
| Identifier Issuer | BCBS REG |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: