Individual
MARK L. VAN OVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4589
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4589
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201500476NP-PP
OR
363LF0000X
Family Nurse Practitioner
NP 17478
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NORTH BEND MEDICAL CENTER GROUP NPI
OR
01
—
161133
NORTH BEND MEDICAL CENTER GROUP MEDICAID
OR
05
—
500712548
—
OR
01
—
R0000WFBTV
NORTH BEND MEDICAL CENTER GROUP MEDICARE
OR
Enumeration date
02/22/2008
Last updated
09/22/2016
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