Provider Demographics
NPI:1801353750
Name:VAN DYKEN, GERI LYNNE (ARNP, CNM)
Entity type:Individual
Prefix:
First Name:GERI
Middle Name:LYNNE
Last Name:VAN DYKEN
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8796 VAN BUREN RD
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-9340
Mailing Address - Country:US
Mailing Address - Phone:360-303-1796
Mailing Address - Fax:
Practice Address - Street 1:400 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1939
Practice Address - Country:US
Practice Address - Phone:360-746-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60938807363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology