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General NPI Number Information
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NPI Number | 1457324576
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Entity Type | Individual
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Provider Name | MIA LYNNE VANEKEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 2181 E PECOS RD STE 1
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City | CHANDLER
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State | AZ
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Zip | 85225-6140
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Country | US
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Telephone | 480-597-4835
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Fax | 833-450-5489
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Provider Business Mailing Address
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Address Line | 3317 S HIGLEY RD STE 114-440
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City | GILBERT
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State | AZ
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Zip | 85297-5436
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Country | US
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Telephone | 480-597-4835
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Fax | 833-450-5489
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 3984
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License Number State | AZ
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