Provider Demographics
NPI:1083342844
Name:ANTHONY, VANESSA JEAN (MPAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JEAN
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 LINGAY DR
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3331
Mailing Address - Country:US
Mailing Address - Phone:412-215-1448
Mailing Address - Fax:
Practice Address - Street 1:6001 STONEWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7380
Practice Address - Country:US
Practice Address - Phone:724-772-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty