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General NPI Number Information
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NPI Number | 1225703770
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Entity Type | Individual
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Provider Name | BRITTNEY LEIGH VAN LAEKEN AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2500 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-2005
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Country | US
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Telephone | 731-394-1145
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19599
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City | BELFAST
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State | ME
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Zip | 04915-4090
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Country | US
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Telephone | 731-394-1145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71011790A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 3018986
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License Number State | KY
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