Individual
JENNIFER VANDE LOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
222 ASHVILLE AVE, CARY, NC 27518-6130
(919) 859-1136
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
(877) 498-4490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-07300
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2017
Last updated
04/14/2021
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