Provider Demographics
NPI:1073216859
Name:VAN KEUREN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:VAN KEUREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-0220
Mailing Address - Country:US
Mailing Address - Phone:320-468-6451
Mailing Address - Fax:
Practice Address - Street 1:26814 143RD ST
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-1556
Practice Address - Country:US
Practice Address - Phone:320-468-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator