Provider Demographics
NPI:1811984974
Name:VAN VOOREN, AMY (PA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:VAN VOOREN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:P O BOX 12156
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23612-2156
Mailing Address - Country:US
Mailing Address - Phone:757-867-6502
Mailing Address - Fax:757-867-6588
Practice Address - Street 1:1705 S. TARBORO STREET
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3428
Practice Address - Country:US
Practice Address - Phone:252-933-8928
Practice Address - Fax:252-399-7477
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2764245OtherMEDICARE CORE
NC2764245OtherMEDICARE CORE
NC2764245Medicare PIN