Provider Demographics
NPI:1154658193
Name:GEORGE, VANESSA ELIEZER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:ELIEZER
Last Name:GEORGE
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 1:5611 CLOVER PL
Mailing Address - Street 2:3L
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6722
Mailing Address - Country:US
Mailing Address - Phone:646-734-2661
Mailing Address - Fax:
Practice Address - Street 1:5611 CLOVER PL
Practice Address - Street 2:3L
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6722
Practice Address - Country:US
Practice Address - Phone:646-734-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily