Provider Demographics
NPI:1952361073
Name:VAN BUREN, NORMA J (LPN / RCS)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:J
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:LPN / RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N11389 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-8604
Mailing Address - Country:US
Mailing Address - Phone:920-324-4685
Mailing Address - Fax:
Practice Address - Street 1:N11389 COUNTY ROAD I
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-8604
Practice Address - Country:US
Practice Address - Phone:920-324-4685
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15121031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse