Provider Demographics
NPI:1588816128
Name:VAN DER GAARDEN, KARIN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:
Last Name:VAN DER GAARDEN
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:GAREELWEG 11
Mailing Address - Street 2:A17
Mailing Address - City:HEERLE
Mailing Address - State:NETHERLANDS
Mailing Address - Zip Code:4726SW
Mailing Address - Country:NL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3715 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2080
Practice Address - Country:US
Practice Address - Phone:505-224-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant