Healthcare Provider Details

I. General information

NPI: 1699187831
Provider Name (Legal Business Name): JONNA ANN MAAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

IV. Provider business mailing address

420 DELAWARE STREET SE PHILLIPS WANGENSTEEN BUILDING 14TH FLOOR, SUITE 100B
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-9661
  • Fax: 507-537-9053
Mailing address:
  • Phone: 612-624-0990
  • Fax: 612-625-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61915
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61915
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: