Provider Demographics
NPI:1336640366
Name:VAN REES, MACKENZIE JEANNE (PA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JEANNE
Last Name:VAN REES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 BLAIRS FERRY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2076
Mailing Address - Country:US
Mailing Address - Phone:193-393-0178
Mailing Address - Fax:
Practice Address - Street 1:1940 BLAIRS FERRY RD STE 104
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2076
Practice Address - Country:US
Practice Address - Phone:193-393-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IA092632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant