Provider Demographics
NPI:1063515419
Name:VAN-NURDEN, MARIA (OD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:VAN-NURDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LITTLE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8752
Mailing Address - Country:US
Mailing Address - Phone:360-416-6735
Mailing Address - Fax:360-424-6954
Practice Address - Street 1:2100 LITTLE MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-8752
Practice Address - Country:US
Practice Address - Phone:360-416-6735
Practice Address - Fax:360-424-6954
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003472WA152W00000X
MNMN2722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1547620OtherAMERICA'S PPO
MN183M0VAOtherBCBS/MN
MNMN2722OtherEYEMED
MN108405400Medicaid
MN2201774OtherMEDICA/UNITED HEALTH CARE
MNU76510Medicare UPIN
MN410001958Medicare ID - Type Unspecified