Provider Demographics
NPI:1952069916
Name:VAN SOLKEMA, MORGAN JAE (PA-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:JAE
Last Name:VAN SOLKEMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18445-2142
Mailing Address - Country:US
Mailing Address - Phone:570-994-8435
Mailing Address - Fax:
Practice Address - Street 1:100 ST LUKES LN
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6217
Practice Address - Country:US
Practice Address - Phone:866-785-8537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063236363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical