Calli Jean Van Dam, AGPCNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN1032619 Issued in DC

Practice address

10215 Fernwood Rd
Ste 506
Bethesda, MD 20817-1184

Phone

(301) 530-1010

Fax

(301) 897-8597

NPI assigned

Dec 4, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551744000000",
    "number": "1205201035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10215 FERNWOOD RD",
            "address_2": "STE 506",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208171184",
            "telephone_number": "301-530-1010",
            "fax_number": "301-897-8597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 FERNWOOD RD",
            "address_2": "STE 506",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208171184",
            "telephone_number": "301-530-1010",
            "fax_number": "301-897-8597"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2150 Pennsylvania Ave NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200373201",
            "country_code": "US",
            "telephone_number": "202-741-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN DAM",
        "first_name": "CALLI",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-04",
        "last_updated": "2019-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DC",
            "license": "RN1032619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "0024175551",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AC002241",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chanin Rose Van Thiel
• Holly Van Winter

• Nurse Practitioner in Bethesda, MD
• Providers in Bethesda, MD by specialty
• Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.