Provider Demographics
NPI:1376914192
Name:VAN DAM, ANNETTE (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:VAN DAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:796 NINEVAH RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-7960
Mailing Address - Country:US
Mailing Address - Phone:888-731-8994
Mailing Address - Fax:
Practice Address - Street 1:21 E. STATE ST. OFFICE 233 COLUMBUS, OH 43215
Practice Address - Street 2:OFFIXE 233
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009783363L00000X, 208D00000X, 207QA0505X, 202D00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily