Provider Demographics
NPI:1366425647
Name:VANWILLIGEN, LAUREL CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:CHRISTINE
Last Name:VANWILLIGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:IA
Mailing Address - Zip Code:52201-9286
Mailing Address - Country:US
Mailing Address - Phone:319-653-1088
Mailing Address - Fax:
Practice Address - Street 1:2854 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:IA
Practice Address - Zip Code:52201-9286
Practice Address - Country:US
Practice Address - Phone:319-653-1088
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27244207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine