Provider Demographics
NPI:1437519717
Name:VAN DEN BERG, CORTNEY
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:VAN DEN BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:JANZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1621 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-8902
Mailing Address - Country:US
Mailing Address - Phone:402-723-4512
Mailing Address - Fax:402-723-4520
Practice Address - Street 1:1621 FRONT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-8902
Practice Address - Country:US
Practice Address - Phone:402-723-4512
Practice Address - Fax:402-723-4520
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1994363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical