Provider Demographics
NPI:1730121187
Name:VAN DAM, DONALD LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LEE
Last Name:VAN DAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9501 FARRELL RD
Mailing Address - Street 2:DEWITT ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5901
Mailing Address - Country:US
Mailing Address - Phone:703-805-0342
Mailing Address - Fax:703-805-0731
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:DEWITT ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0342
Practice Address - Fax:703-805-0731
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered