Healthcare Provider Details

I. General information

NPI: 1912560012
Provider Name (Legal Business Name): LAUREN ANN STOECKMANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN VANDEVELDE

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 CHAMPIONS WAY
SUFFOLK VA
23435-3914
US

IV. Provider business mailing address

860 OMNI BLVD STE 101
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-6118
  • Fax: 757-967-9003
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9112029
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006941
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: