Provider Demographics
NPI:1588328645
Name:VAN HEUKELUM, SARA A (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:VAN HEUKELUM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 FRONT ROYAL PIKE STE 205
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-4324
Mailing Address - Country:US
Mailing Address - Phone:540-450-0334
Mailing Address - Fax:
Practice Address - Street 1:158 FRONT ROYAL PIKE STE 205
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4324
Practice Address - Country:US
Practice Address - Phone:540-450-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182946363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health