Provider Demographics
NPI:1043006703
Name:VAN SUMEREN, ANDREW JAMES (SOTM, WP-C, NRP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:VAN SUMEREN
Suffix:
Gender:
Credentials:SOTM, WP-C, NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-4433
Mailing Address - Country:US
Mailing Address - Phone:906-440-8323
Mailing Address - Fax:
Practice Address - Street 1:2603 LOWER GAINSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:STENNIS SPACE CENTER
Practice Address - State:MS
Practice Address - Zip Code:39529-0001
Practice Address - Country:US
Practice Address - Phone:906-440-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider