Provider Demographics
NPI:1255185427
Name:VANDER FEEN, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:VANDER FEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:HELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5316 W 76TH TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4717
Mailing Address - Country:US
Mailing Address - Phone:605-370-8117
Mailing Address - Fax:
Practice Address - Street 1:20375 W 151ST ST STE 301
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7207
Practice Address - Country:US
Practice Address - Phone:913-588-0347
Practice Address - Fax:913-588-6055
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-12413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine