Provider Demographics
NPI:1134663958
Name:SIEGRIST, VANESSA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:WINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:280 OLD LAMBERT RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3526
Mailing Address - Country:US
Mailing Address - Phone:203-952-7415
Mailing Address - Fax:
Practice Address - Street 1:400 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3576
Practice Address - Country:US
Practice Address - Phone:860-305-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner