Provider Demographics
NPI:1891994703
Name:VANBAALEN, ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:VANBAALEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4024
Mailing Address - Country:US
Mailing Address - Phone:307-760-8790
Mailing Address - Fax:
Practice Address - Street 1:710 E GARFIELD ST STE 126
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3979
Practice Address - Country:US
Practice Address - Phone:307-745-8832
Practice Address - Fax:307-745-8832
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38966207Q00000X
WY6760A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH70216Medicare UPIN