Provider Demographics
NPI:1093148397
Name:HOWARD, VANESSA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W MONTEREY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4257
Mailing Address - Country:US
Mailing Address - Phone:773-298-9800
Mailing Address - Fax:773-298-9901
Practice Address - Street 1:1701 W MONTEREY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4257
Practice Address - Country:US
Practice Address - Phone:773-298-9800
Practice Address - Fax:773-298-9901
Is Sole Proprietor?:No
Enumeration Date:2013-08-10
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily