Provider Demographics
NPI:1376596361
Name:VON HOLLEN, NAOMI JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:JEAN
Last Name:VON HOLLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:JEAN
Other - Last Name:SYNSTEGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-2592
Practice Address - Fax:360-428-2560
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS-088067363L00000X
WAAP60396767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0477760Medicaid
S26297Medicare UPIN
IA0477760Medicaid