Provider Demographics
NPI:1114274859
Name:VAN HOUWELING, AUDRY B (ARNP)
Entity Type:Individual
Prefix:
First Name:AUDRY
Middle Name:B
Last Name:VAN HOUWELING
Suffix:
Gender:F
Credentials:ARNP
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 2206
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-2206
Mailing Address - Country:US
Mailing Address - Phone:541-595-8337
Mailing Address - Fax:971-983-5326
Practice Address - Street 1:204 W ADAMS AVE STE 202
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2517
Practice Address - Country:US
Practice Address - Phone:541-595-8337
Practice Address - Fax:503-200-1433
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60297379363L00000X, 363LP0808X
OR201403159NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114274859Medicaid
WA0297873OtherL&I
WA1114274859Medicaid
WAG8912446Medicare PIN