Provider Demographics
NPI:1003923178
Name:DE DANZINE, VANESSA (PA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DE DANZINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1 BROOKDALE PLZ
Mailing Address - Street 2:BROOKDALE UNIVERSITY HOSPITAL & MEDICAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-5180
Mailing Address - Fax:718-240-6655
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:BROOKDALE UNIVERSITY HOSPITAL & MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5180
Practice Address - Fax:718-240-6655
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP48796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant