Provider Demographics
NPI:1235620303
Name:HALVORSEN, VANESSA ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ELIZABETH
Last Name:HALVORSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 SOLITUDE POINT AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5453
Mailing Address - Country:US
Mailing Address - Phone:801-910-9456
Mailing Address - Fax:
Practice Address - Street 1:1031 MCINTOSH CIR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3643
Practice Address - Country:US
Practice Address - Phone:417-347-5665
Practice Address - Fax:417-347-9089
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program