Provider Demographics
NPI:1003480237
Name:DICUS, VANESSA (APRN-CNP)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:DICUS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20672 E KAMBRIE RD
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-5349
Mailing Address - Country:US
Mailing Address - Phone:405-659-6711
Mailing Address - Fax:
Practice Address - Street 1:20567 E KAMBRIE RD
Practice Address - Street 2:
Practice Address - City:INOLA
Practice Address - State:OK
Practice Address - Zip Code:74036-5334
Practice Address - Country:US
Practice Address - Phone:405-659-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0122192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty