Provider Demographics
NPI:1255662334
Name:LYTES, VANESSA RENEE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:RENEE
Last Name:LYTES
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:8TH FLOOR PP
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:215-707-6230
Mailing Address - Fax:215-707-2684
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:8TH FLOOR PP
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-6230
Practice Address - Fax:215-707-2684
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP005705C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health