Provider Demographics
NPI:1740260983
Name:VAN DE MERWE, TINEKE (NP)
Entity type:Individual
Prefix:MS
First Name:TINEKE
Middle Name:
Last Name:VAN DE MERWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 HWAY 395 N
Mailing Address - Street 2:10
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410
Mailing Address - Country:US
Mailing Address - Phone:760-932-9932
Mailing Address - Fax:
Practice Address - Street 1:1329 HIGHWAY 395 NORTH
Practice Address - Street 2:10
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410
Practice Address - Country:US
Practice Address - Phone:760-932-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA346540 NP 8437363LF0000X
NV000901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ42628Medicare UPIN