Provider Demographics
NPI:1437128436
Name:VANOUWERKERK, MARJA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARJA
Middle Name:
Last Name:VANOUWERKERK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 OLD HIGHWAY 22
Mailing Address - Street 2:MORNING STAR FHC
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1389
Mailing Address - Country:US
Mailing Address - Phone:908-735-9344
Mailing Address - Fax:908-735-7136
Practice Address - Street 1:54 OLD HIGHWAY 22
Practice Address - Street 2:MORNING STAR FAMILY HEALTH CENTER
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1389
Practice Address - Country:US
Practice Address - Phone:908-735-9344
Practice Address - Fax:908-735-7136
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP000292000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant