Basic Information
| Provider Information | |||||||||
| NPI: | 1750359790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN ES | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 WEBBER ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970583527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412964804 | ||||||||
| FaxNumber: | 5412963741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 WEBBER ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412964804 | ||||||||
| FaxNumber: | 5412963741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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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 | 363L00000X | 200150061NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 276457 | 05 | OR | MEDICAID | 9634841 | 05 | WA | MEDICAID |