Provider Demographics
NPI:1578573580
Name:VAN HORSSEN, JAMIE (FNPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:VAN HORSSEN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 COLONIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4948
Mailing Address - Country:US
Mailing Address - Phone:406-442-1231
Mailing Address - Fax:406-442-8201
Practice Address - Street 1:2619 COLONIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4948
Practice Address - Country:US
Practice Address - Phone:406-442-1231
Practice Address - Fax:406-442-8201
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT017232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT430134Medicaid
MT80398Medicare ID - Type Unspecified
MT430134Medicaid