Provider Demographics
NPI:1093926784
Name:JEFFERSON, VANESSA LOUISE (MSN, C-ANP, CDE)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LOUISE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MSN, C-ANP, CDE
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 208237
Mailing Address - Street 2:55 LOCK STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8237
Mailing Address - Country:US
Mailing Address - Phone:203-432-0076
Mailing Address - Fax:203-432-7289
Practice Address - Street 1:55 LOCK STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8237
Practice Address - Country:US
Practice Address - Phone:203-432-0076
Practice Address - Fax:203-432-7289
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002035363LP2300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care