Provider Demographics
NPI:1669735882
Name:VANDUREN, JOSCELYN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JOSCELYN
Middle Name:
Last Name:VANDUREN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 PIPER ST
Mailing Address - Street 2:ULL002
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-212-3186
Mailing Address - Fax:907-212-3665
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:ULL002
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-212-3186
Practice Address - Fax:907-212-3665
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUR R 25025163W00000X
AKNUR U 1305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1600971Medicaid
AKK165295OtherPTAN