Provider Demographics
NPI:1922556000
Name:VELDHUYZEN, JEN M (MD)
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:M
Last Name:VELDHUYZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:FINELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2003 PLANK RD # 1089
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5103
Mailing Address - Country:US
Mailing Address - Phone:214-612-3863
Mailing Address - Fax:
Practice Address - Street 1:539 W COMMERCE ST # 213
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-1953
Practice Address - Country:US
Practice Address - Phone:214-612-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
VA0101265916208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101265916OtherVIRGINIA MEDICAL LICENSE
TXT3896OtherTEXAS MEDICAL LICENSE