Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 3984 | AZ |
Y | 207VX0000X | Obstetrician | 3984 | AZ |
NPI | 1457324576 |
---|---|
Provider Name | Dr. Mia Lynne Vaneken |
First Address | Gilbert, AZ 85297-7309 |
Second Address | Gilbert, AZ 85297-7309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 30/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
872532 | (05) | AZ |
H71493 | (02) | AZ |