Provider Demographics
NPI:1144838830
Name:VAN DE VELDE, FIONA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:FIONA
Middle Name:
Last Name:VAN DE VELDE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:FLINTSTONE
Mailing Address - State:MD
Mailing Address - Zip Code:21530-0009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:957 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7356
Practice Address - Country:US
Practice Address - Phone:240-362-7128
Practice Address - Fax:240-362-7129
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily