Provider Demographics
NPI:1609038330
Name:FORCE, MARY VANOYEN (MS, ANP-BC, BSN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:VANOYEN
Last Name:FORCE
Suffix:
Gender:F
Credentials:MS, ANP-BC, BSN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:VANOYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2125 E LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2274
Mailing Address - Country:US
Mailing Address - Phone:719-219-3402
Mailing Address - Fax:
Practice Address - Street 1:2125 E LA SALLE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2274
Practice Address - Country:US
Practice Address - Phone:719-219-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041317990163W00000X
IL209007044363LA2200X, 363L00000X
COAPN.0990591-NP261Q00000X
CORN.1619124261Q00000X
MI4704131231261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid