Provider Demographics
NPI:1467047928
Name:WINDFIELD, VANESSA LASCHELLE SHANAE (LVN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LASCHELLE SHANAE
Last Name:WINDFIELD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LS
Other - Last Name:EDDINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:5085 N DEL MAR AVE APT J
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2806
Mailing Address - Country:US
Mailing Address - Phone:559-284-2107
Mailing Address - Fax:
Practice Address - Street 1:4441 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3604
Practice Address - Country:US
Practice Address - Phone:555-600-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690344164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty