Provider Demographics
NPI:1497133417
Name:VELDHUYZEN, MARIE LOUISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LOUISE
Last Name:VELDHUYZEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:V
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2511 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6466
Mailing Address - Country:US
Mailing Address - Phone:540-786-1200
Mailing Address - Fax:540-786-3195
Practice Address - Street 1:125 OLDE GREENWICH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408
Practice Address - Country:US
Practice Address - Phone:540-374-5599
Practice Address - Fax:540-735-8097
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant