Healthcare Provider Details

I. General information

NPI: 1992848261
Provider Name (Legal Business Name): STEPHEN E VAN NOY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 BOX BUTTE AVE.
ALLIANCE NE
69301
US

IV. Provider business mailing address

2101 BOX BUTTE AVE
ALLIANCE NE
69301
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-7244
  • Fax: 308-762-6657
Mailing address:
  • Phone: 308-762-7244
  • Fax: 308-762-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number875
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: