Provider Demographics
NPI:1093957847
Name:WITHEE, VANESSA (FNP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:WITHEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 W GALAXY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6004
Mailing Address - Country:US
Mailing Address - Phone:559-776-1927
Mailing Address - Fax:
Practice Address - Street 1:4126 W GALAXY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6004
Practice Address - Country:US
Practice Address - Phone:559-776-1927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17300OtherCALIFORNIA LICENSE
CAEP440AMedicare PIN