Provider Demographics
NPI:1558780221
Name:VAN REESEN, WHITNEY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MARIE
Last Name:VAN REESEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MARIE
Other - Last Name:VANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1025 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1304
Mailing Address - Country:US
Mailing Address - Phone:920-648-4518
Mailing Address - Fax:920-648-1623
Practice Address - Street 1:1025 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551
Practice Address - Country:US
Practice Address - Phone:920-648-1451
Practice Address - Fax:920-648-1623
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI65144-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program