Provider Demographics
NPI:1528024593
Name:VAN VIANENRYDER, MARIA JOHANNA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:JOHANNA
Last Name:VAN VIANENRYDER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 CUTTING DIAMOND CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-3066
Mailing Address - Country:US
Mailing Address - Phone:702-562-2173
Mailing Address - Fax:702-562-2174
Practice Address - Street 1:VA SOUTHERN NEVADA HEATHCARE SYSTEM
Practice Address - Street 2:1841 E. CRAIG ROAD
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89036
Practice Address - Country:US
Practice Address - Phone:702-636-3000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289204363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health