Provider Demographics
NPI:1104451780
Name:VAN ECK, JAMES EDWARD III
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:VAN ECK
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N 4TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3444
Mailing Address - Country:US
Mailing Address - Phone:906-202-2865
Mailing Address - Fax:
Practice Address - Street 1:301 N 4TH ST APT 5
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3444
Practice Address - Country:US
Practice Address - Phone:906-202-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703116365164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse