Provider Demographics
NPI:1083654586
Name:NORTON, VANESSA (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:NORTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-579-8363
Mailing Address - Fax:910-579-8306
Practice Address - Street 1:9970 BEACH DR SW
Practice Address - Street 2:SUITE 1
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2741
Practice Address - Country:US
Practice Address - Phone:910-579-8363
Practice Address - Fax:910-579-8306
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0002-01907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006043Medicaid
NC7006043Medicaid
NCNC6135AMedicare PIN