Provider Demographics
NPI:1083906804
Name:VANESSA FOWLKES NP LLC
Entity Type:Organization
Organization Name:VANESSA FOWLKES NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:PEYTON
Authorized Official - Last Name:FOWLKES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:804-405-9448
Mailing Address - Street 1:2447 CROWNCREST DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2517
Mailing Address - Country:US
Mailing Address - Phone:804-405-9448
Mailing Address - Fax:804-482-2830
Practice Address - Street 1:2447 CROWNCREST DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-2517
Practice Address - Country:US
Practice Address - Phone:804-405-9448
Practice Address - Fax:804-482-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164743163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty