Healthcare Provider Details

I. General information

NPI: 1619149911
Provider Name (Legal Business Name): REBECCA K VANDERSTOUWE MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 MCLAWS CIR SUITE 1
WILLIAMSBURG VA
23185-5645
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-221-0750
  • Fax: 757-229-5168
Mailing address:
  • Phone: 757-594-4006
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001062299
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167769
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: