Provider Demographics
NPI:1922174317
Name:VANDUYNHOVEN, JOAN A (RN BSN CNM)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:A
Last Name:VANDUYNHOVEN
Suffix:
Gender:F
Credentials:RN BSN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WEST FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701
Mailing Address - Country:US
Mailing Address - Phone:406-497-5080
Mailing Address - Fax:406-497-5099
Practice Address - Street 1:25 WEST FRONT STREET
Practice Address - Street 2:BUTTE FAMILY PLANNING
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701
Practice Address - Country:US
Practice Address - Phone:406-497-5080
Practice Address - Fax:406-497-5099
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN14715163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT36260OtherBCBS
MT430222Medicaid
MT36260OtherBCBS