Provider Demographics
NPI:1154373306
Name:VAN DEN EINDE, MAUREEN ROSE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ROSE
Last Name:VAN DEN EINDE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 170TH STR
Mailing Address - Street 2:
Mailing Address - City:BEJOU
Mailing Address - State:MN
Mailing Address - Zip Code:56516
Mailing Address - Country:US
Mailing Address - Phone:218-935-2631
Mailing Address - Fax:
Practice Address - Street 1:40520 CO HWY 34
Practice Address - Street 2:WHITE EARTH HEALTH CENTER
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569
Practice Address - Country:US
Practice Address - Phone:218-983-4300
Practice Address - Fax:218-983-6217
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1041495163W00000X, 163WG0000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care