Provider Demographics
NPI:1962982371
Name:VANDERVEEN, MEGAN R (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:VANDERVEEN
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:R
Other - Last Name:SCHADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1908 N LAURENT ST STE 250
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5417
Mailing Address - Country:US
Mailing Address - Phone:361-576-0694
Mailing Address - Fax:
Practice Address - Street 1:2735 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3306
Practice Address - Country:US
Practice Address - Phone:361-992-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53571363L00000X
TXAP145976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67021034Medicaid