Provider Demographics
NPI:1992848261
Name:VAN NOY, STEPHEN E (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:VAN NOY
Suffix:
Gender:M
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 1:2101 BOX BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301
Mailing Address - Country:US
Mailing Address - Phone:308-762-7244
Mailing Address - Fax:308-762-6657
Practice Address - Street 1:2101 BOX BUTTE AVE.
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301
Practice Address - Country:US
Practice Address - Phone:308-762-7244
Practice Address - Fax:308-762-6657
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP14684Medicare UPIN