Provider Demographics
NPI:1669008645
Name:VANDERVEEN, NATHAN TUCKER (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:TUCKER
Last Name:VANDERVEEN
Suffix:
Gender:M
Credentials:MD
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 362
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-0362
Mailing Address - Country:US
Mailing Address - Phone:269-650-0855
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLAZA, INTERNAL MEDICINE - PEDIATRICS
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7419
Practice Address - Country:US
Practice Address - Phone:310-267-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program