Active NPI
Irma Johanna Van Der Valk, NP
- Nurse Practitioner
- Woodbury, MN
National Provider Identifier
1982718896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R148448-9
- Practice address
- 1925 Woodwinds Dr
Woodbury, MN 55125-2270 - Phone
- (651) 232-0100
- NPI assigned
- Aug 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R148448-9 | MN | Primary |
Addresses
Primary practice location
1925 Woodwinds Dr
Woodbury, MN 55125-2270
Mailing address
1114 Lane PL
Saint Paul, MN 55106-2807
Phone (651) 264-1345
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 550617400 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R148448-9 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982718896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1114 LANE PL",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551062807",
"telephone_number": "651-264-1345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 WOODWINDS DR",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252270",
"telephone_number": "651-232-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DER VALK",
"first_name": "IRMA",
"middle_name": "JOHANNA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R148448-9",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "550617400",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.