Provider Demographics
NPI:1114345071
Name:CEPEDA, VANESSA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 HONEY CREEK CIR
Mailing Address - Street 2:UNIT 701
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-9793
Mailing Address - Country:US
Mailing Address - Phone:262-374-3925
Mailing Address - Fax:
Practice Address - Street 1:2544 HONEY CREEK CIR
Practice Address - Street 2:UNIT 701
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-9793
Practice Address - Country:US
Practice Address - Phone:262-374-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122468-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse