Provider Demographics
NPI:1093894644
Name:VAN HORN, VIRGINIA G (CRNA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:G
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:GALE
Other - Last Name:MCKEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1731 OAK GLN
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3839
Mailing Address - Country:US
Mailing Address - Phone:203-509-2094
Mailing Address - Fax:
Practice Address - Street 1:12850 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-4115
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered