Provider Demographics
NPI:1689162588
Name:VANHOUTEN, WYNN
Entity Type:Individual
Prefix:
First Name:WYNN
Middle Name:
Last Name:VANHOUTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15230 FIR RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77517-2914
Mailing Address - Country:US
Mailing Address - Phone:832-545-0232
Mailing Address - Fax:
Practice Address - Street 1:15230 FIR RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77517-2914
Practice Address - Country:US
Practice Address - Phone:832-545-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily