Provider Demographics
NPI:1063842219
Name:VAN AMAN, MARY NANCY (DNP, RN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:NANCY
Last Name:VAN AMAN
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BIG BEND WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7555
Mailing Address - Country:US
Mailing Address - Phone:314-412-0898
Mailing Address - Fax:
Practice Address - Street 1:816 BIG BEND WOODS DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7555
Practice Address - Country:US
Practice Address - Phone:314-412-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010012193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily