Provider Demographics
NPI:1649845827
Name:VAN, MARK L (RN, CEN, CFRN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:VAN
Suffix:
Gender:M
Credentials:RN, CEN, CFRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4735
Mailing Address - Country:US
Mailing Address - Phone:201-916-7539
Mailing Address - Fax:
Practice Address - Street 1:899 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-4735
Practice Address - Country:US
Practice Address - Phone:201-916-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11189800163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WF0300XNursing Service ProvidersRegistered NurseFlightGroup - Single Specialty