Provider Demographics
NPI:1104693324
Name:VAN FOSSEN, LAURA MAE (RN, CNM)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MAE
Last Name:VAN FOSSEN
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALYSE CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1663
Mailing Address - Country:US
Mailing Address - Phone:856-796-3234
Mailing Address - Fax:
Practice Address - Street 1:435 HURFFVILLE- CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-582-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00085101367A00000X
NJ26RN16127800163W00000X
NJ25ME00085100367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse