Healthcare Provider Details

I. General information

NPI: 1467882704
Provider Name (Legal Business Name): KARIE VANDER WERF D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 LURIA LN
CHAMPAIGN IL
61822-1107
US

IV. Provider business mailing address

704 LURIA LN
CHAMPAIGN IL
61822-1107
US

V. Phone/Fax

Practice location:
  • Phone: 561-271-5489
  • Fax:
Mailing address:
  • Phone: 561-271-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number7526
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number9963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: