| Doctor Name: | MR. MARK A DAMMEN |
| NPI Number: | 1689720385 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | R25438 |
| Business Practice Address: | 1st Medical Group 45 Pine Street Langley Afb, VA - 236652080 |
| Business Phone Number: | 7577645481 |
| Business Fax Number: | |
| Mailing Address: | 1300 Lakeridge Rd, Apt 202 HAMPTON |
| State: | VA |
| Postal Code: | 236666069 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R25438 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |