Provider Demographics
NPI:1962648162
Name:VANDER VEEN, KATHRYN (MSN, APRN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:VANDER VEEN
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6667 160TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:IA
Mailing Address - Zip Code:51345-7512
Mailing Address - Country:US
Mailing Address - Phone:712-722-6428
Mailing Address - Fax:
Practice Address - Street 1:498 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1606
Practice Address - Country:US
Practice Address - Phone:712-722-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-114107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily