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NPI Code Detail

MEDICARE: MRS. AMY VAN VOOREN P.A.

MEDICARE: MRS. AMY VAN VOOREN P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant103186NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12764245OTHERNCMEDICARE CORE

General Provider Information

NPI Number : 1811984974
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY VAN VOOREN P.A.
Provider Business Mailing Address
First Line : P O BOX 12156
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23612-2156
Country : US
Telephone Number : 757-867-6502
Fax Number : 757-867-6588
Provider Business Practice Location Address
First Line : 1705 S. TARBORO STREET
Second Line :
City : WILSON
State : NC
Zip : 27893-3428
Country : US
Telephone Number : 252-933-8928
Fax Number : 252-399-7477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 03/07/2023

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