Individual
GINA LYNN VAN AUSDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHW
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
G-1740
NM
175T00000X
Peer Specialist
Primary
G-1740
NM
Other
Enumeration date
03/27/2025
Last updated
02/24/2026
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