Provider Demographics
NPI:1912577412
Name:VAN DER MEYDEN, MIKAELA (CRNA)
Entity Type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:
Last Name:VAN DER MEYDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:DR
Other - First Name:MIKAELA
Other - Middle Name:
Other - Last Name:SIEMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2767 GREGORY CT
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7121
Mailing Address - Country:US
Mailing Address - Phone:918-520-8658
Mailing Address - Fax:
Practice Address - Street 1:1010 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2507
Practice Address - Country:US
Practice Address - Phone:919-690-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK117179163W00000X
NC363924163W00000X
VA0024182630367500000X
NC7260367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse