Healthcare Provider Details

I. General information

NPI: 1457324576
Provider Name (Legal Business Name): MIA LYNNE VANEKEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 E PECOS RD STE 1
CHANDLER AZ
85225-6140
US

IV. Provider business mailing address

3317 S HIGLEY RD STE 114-440
GILBERT AZ
85297-5436
US

V. Phone/Fax

Practice location:
  • Phone: 480-597-4835
  • Fax: 833-450-5489
Mailing address:
  • Phone: 480-597-4835
  • Fax: 833-450-5489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number3984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: