Provider Demographics
NPI:1376204222
Name:VAN LEEUWEN, MAYSIE JONES
Entity type:Individual
Prefix:
First Name:MAYSIE
Middle Name:JONES
Last Name:VAN LEEUWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 E 9400 S STE 109
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3687
Mailing Address - Country:US
Mailing Address - Phone:385-271-9720
Mailing Address - Fax:800-455-1391
Practice Address - Street 1:870 E 9400 S STE 109
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3687
Practice Address - Country:US
Practice Address - Phone:385-271-9720
Practice Address - Fax:800-455-1391
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant