Provider Demographics
NPI:1982156873
Name:VANCAMP, JOHN DEREK (DNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DEREK
Last Name:VANCAMP
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:DEREK
Other - Last Name:VANCAMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:1238 BROOKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1628
Mailing Address - Country:US
Mailing Address - Phone:805-338-5498
Mailing Address - Fax:
Practice Address - Street 1:1238 BROOKVIEW AVE
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1628
Practice Address - Country:US
Practice Address - Phone:805-338-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005329363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care