Provider Demographics
NPI:1417355785
Name:VANOEVEREN, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VANOEVEREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:DORR
Mailing Address - State:MI
Mailing Address - Zip Code:49323-9378
Mailing Address - Country:US
Mailing Address - Phone:616-581-8279
Mailing Address - Fax:
Practice Address - Street 1:1721 MARGARET DR
Practice Address - Street 2:
Practice Address - City:DORR
Practice Address - State:MI
Practice Address - Zip Code:49323-9378
Practice Address - Country:US
Practice Address - Phone:616-581-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703083006164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse