Individual
IRMA JOHANNA VAN DER VALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1925 WOODWINDS DR, WOODBURY, MN 55125-2270
(651) 232-0100
Mailing address
1114 LANE PL, SAINT PAUL, MN 55106-2807
(651) 264-1345
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R148448-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
550617400
—
MN
Enumeration date
08/18/2006
Last updated
07/08/2007
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