MEDICARE: MRS. MARIE LOUISE VELDHUYZEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110004879	VA
2	363A00000X	Physician Assistant	4666	SC

General Provider Information

NPI Number	:	1497133417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE LOUISE VELDHUYZEN PA-C

Provider Business Mailing Address
First Line	:	1561 US-17
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566
Country	:	US
Telephone Number	:	843-490-2686
Fax Number	:

Provider Business Practice Location Address
First Line	:	1561 U.S. 17
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566
Country	:	US
Telephone Number	:	843-490-2686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	02/12/2026

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