Provider Demographics
NPI:1457659922
Name:SANNE, VANESSA KATHLEEN (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:KATHLEEN
Last Name:SANNE
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 SE 61ST PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6789
Mailing Address - Country:US
Mailing Address - Phone:503-356-2385
Mailing Address - Fax:
Practice Address - Street 1:265 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1800
Practice Address - Country:US
Practice Address - Phone:503-280-1223
Practice Address - Fax:503-528-5252
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050213NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500638078Medicaid