Provider Demographics
NPI:1649873530
Name:VANWART, VIRGINIA (FNP)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:VANWART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:VANWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 4749
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0227
Mailing Address - Country:US
Mailing Address - Phone:541-789-4111
Mailing Address - Fax:541-789-5518
Practice Address - Street 1:3011 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-789-4673
Practice Address - Fax:541-789-2121
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202010481NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily