Provider Demographics
NPI:1700235868
Name:VAN DOREN, JOANNA (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:VAN DOREN
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCOBEE CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4887
Mailing Address - Country:US
Mailing Address - Phone:508-747-0711
Mailing Address - Fax:508-746-9265
Practice Address - Street 1:1 SCOBEE CIR STE 3
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4887
Practice Address - Country:US
Practice Address - Phone:508-747-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5711363A00000X
RIPA00877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant