1669735882 NPI number — MRS. JOSCELYN VANDUREN FNP-C

Table of content: MRS. JOSCELYN VANDUREN FNP-C (NPI 1669735882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669735882 NPI number — MRS. JOSCELYN VANDUREN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDUREN
Provider First Name:
JOSCELYN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669735882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3851 PIPER ST
Provider Second Line Business Mailing Address:
ULL002
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-212-3186
Provider Business Mailing Address Fax Number:
907-212-3665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3851 PIPER ST
Provider Second Line Business Practice Location Address:
ULL002
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-212-3186
Provider Business Practice Location Address Fax Number:
907-212-3665
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  NUR R 25025 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: NUR U 1305 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1600971 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: K165295 . This is a "PTAN" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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