Provider Demographics
NPI:1093767964
Name:VAN DASK, JOANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:VAN DASK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-3200
Mailing Address - Country:US
Mailing Address - Phone:717-544-3232
Mailing Address - Fax:717-544-3233
Practice Address - Street 1:2112 HARRISBURG PIKE
Practice Address - Street 2:SUITE 312
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604-3200
Practice Address - Country:US
Practice Address - Phone:717-544-3232
Practice Address - Fax:717-544-3233
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006886M207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA047286GQCMedicare ID - Type Unspecified
PAP30391Medicare UPIN