Provider Demographics
NPI:1689801706
Name:VAN DEN BERG, DEBORAH K (GNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:VAN DEN BERG
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17385 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421-3882
Mailing Address - Country:US
Mailing Address - Phone:757-665-5996
Mailing Address - Fax:757-665-5973
Practice Address - Street 1:17385 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421-3882
Practice Address - Country:US
Practice Address - Phone:757-665-5996
Practice Address - Fax:757-665-5973
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168528261QP2300X
MI4704176420363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology