Provider Demographics
NPI:1144620410
Name:PRUSIA, VANESSA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:PRUSIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 W 74TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2229
Mailing Address - Country:US
Mailing Address - Phone:913-677-3113
Mailing Address - Fax:
Practice Address - Street 1:9119 W 74TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2229
Practice Address - Country:US
Practice Address - Phone:913-677-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily