Provider Demographics
NPI:1023016805
Name:VAN KAINEN, BARBARA ROSE (CNM)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ROSE
Last Name:VAN KAINEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DRIVE
Practice Address - Street 2:VON VOIGTLANDER WOMEN'S HOSPITAL
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-4256
Practice Address - Country:US
Practice Address - Phone:734-936-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06656176B00000X
MI4704188734367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2301048Medicaid
OH05225OtherPARAMOUNT
OH344428256058OtherCARESOURCE
MI1023016805Medicaid
OH344428256OtherFRONTPATH
OH000000224587OtherANTHEM
OH344428256OtherBEECHSTREET
OH75721Medicare PIN
OH344428256OtherBEECHSTREET
OH61486Medicare UPIN