Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0438000444 | VA |
NPI | 1083134324 |
---|---|
Provider Name | Rabecca Vanevenhoven |
First Address | Fairfax, VA 22030-2840 |
Second Address | Fairfax, VA 22030-2840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 06/08/2021 |