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General NPI Number Information
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NPI Number | 1588235105
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Entity Type | Individual
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Provider Name | FREDERICK JACOBUS VAN VUUREN
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Gender | Male
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 377 W RIVER WOODS PKWY STE 201
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City | GLENDALE
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State | WI
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Zip | 53212-1088
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Country | US
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Telephone | 414-323-6880
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 W MANGOLD AVE
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City | MILWAUKEE
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State | WI
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Zip | 53221-4965
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Country | US
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Telephone | 262-777-0798
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10598
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License Number State | WI
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