Provider Demographics
NPI:1841640687
Name:VANDERLAAG, JANE LOUISE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:LOUISE
Last Name:VANDERLAAG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:LOUISE
Other - Last Name:GUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18880 CHERRY VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9506
Mailing Address - Country:US
Mailing Address - Phone:209-928-5400
Mailing Address - Fax:209-928-5412
Practice Address - Street 1:18880 CHERRY VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9506
Practice Address - Country:US
Practice Address - Phone:209-928-5400
Practice Address - Fax:209-928-5412
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004419363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner