Provider Demographics
NPI:1457324576
Name:VANEKEN, MIA LYNNE (DO)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:LYNNE
Last Name:VANEKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3317 S HIGLEY RD STE 114-440
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5436
Mailing Address - Country:US
Mailing Address - Phone:480-597-4835
Mailing Address - Fax:833-450-5489
Practice Address - Street 1:21321 E OCOTILLO RD STE 127
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5995
Practice Address - Country:US
Practice Address - Phone:480-597-4835
Practice Address - Fax:833-450-4835
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3984207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ872532Medicaid
AZH71493Medicare UPIN
AZ80000Medicare ID - Type Unspecified