Provider Demographics
NPI:1780874081
Name:VAN HAAFTEN, JANA KAY (NP)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:KAY
Last Name:VAN HAAFTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1409
Mailing Address - Country:US
Mailing Address - Phone:515-336-6557
Mailing Address - Fax:515-461-2223
Practice Address - Street 1:1215 PLEASANT ST STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1409
Practice Address - Country:US
Practice Address - Phone:515-336-6557
Practice Address - Fax:515-461-2223
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9423192363L00000X
MNR1664089363L00000X
IAA154489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA154489OtherIOWA LICENSE
MN500004057OtherMEDICARE
MNHP83093OtherHEALTHPARTNERS
MN7C746VAOtherBCBS
IAA154489OtherIOWA LICENSE
MN7C746VAOtherBCBS
MNHP83093OtherHEALTHPARTNERS
MN0127737OtherMEDICA PRIMARY
WI36040400Medicaid