Provider Demographics
NPI:1104642420
Name:VANBOVEN, JOANA HERMINA (PA-S)
Entity type:Individual
Prefix:
First Name:JOANA
Middle Name:HERMINA
Last Name:VANBOVEN
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 HORSESHOE FARM ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6426
Mailing Address - Country:US
Mailing Address - Phone:919-520-6321
Mailing Address - Fax:
Practice Address - Street 1:3746 HORSESHOE FARM ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6426
Practice Address - Country:US
Practice Address - Phone:919-520-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant