Provider Demographics
NPI:1659363612
Name:VAN HORN, SHIRLEY L (FNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:L
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HUGUENOT
Mailing Address - State:NY
Mailing Address - Zip Code:12746
Mailing Address - Country:US
Mailing Address - Phone:845-856-1666
Mailing Address - Fax:845-858-2954
Practice Address - Street 1:17 HAMILTON AVE.
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-794-8080
Practice Address - Fax:845-887-6245
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331954-1363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily