Basic Information
| Provider Information | |||||||||
| NPI: | 1598741829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN DER BIJL | ||||||||
| FirstName: | JOAN | ||||||||
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| Credential: | MSN, CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 STARR AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436052456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1425 STARR AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436052456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
| FaxNumber: | 4199367546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 07/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | NS-02624 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult | 364SP0811X | NS-02624 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Chronically Ill | 364SP0812X | NS-02624 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Community | 364SP0813X | NS-02624 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Geropsychiatric |
ID Information
| ID | Type | State | Issuer | Description | 0050496 | 05 | OH | MEDICAID |