Provider Demographics
NPI:1760556344
Name:VANWIJK, MISCHELLE
Entity Type:Individual
Prefix:
First Name:MISCHELLE
Middle Name:
Last Name:VANWIJK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 LONGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-3115
Mailing Address - Country:US
Mailing Address - Phone:936-760-2784
Mailing Address - Fax:936-760-1950
Practice Address - Street 1:201 ENTERPRISE ROW
Practice Address - Street 2:SUITE 12
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4448
Practice Address - Country:US
Practice Address - Phone:936-760-2784
Practice Address - Fax:936-760-1950
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629327363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health