Provider Demographics
NPI:1851426522
Name:VAN KLEUNEN, ROCHELLE BETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:BETH
Last Name:VAN KLEUNEN
Suffix:
Gender:F
Credentials:FNP
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 128
Mailing Address - Street 2:1 BRIAR LANE
Mailing Address - City:CROMPOND
Mailing Address - State:NY
Mailing Address - Zip Code:10517-0128
Mailing Address - Country:US
Mailing Address - Phone:914-528-0191
Mailing Address - Fax:
Practice Address - Street 1:2090 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1454
Practice Address - Country:US
Practice Address - Phone:914-788-6000
Practice Address - Fax:914-788-6100
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331881-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP95375Medicare UPIN
NY0115G1Medicare ID - Type Unspecified