Provider Demographics
NPI:1497092530
Name:SCULLY, VANESSA L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:L
Last Name:SCULLY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:L
Other - Last Name:LIPPINCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2462
Mailing Address - Country:US
Mailing Address - Phone:402-391-4855
Mailing Address - Fax:402-391-6818
Practice Address - Street 1:7822 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3629
Practice Address - Country:US
Practice Address - Phone:402-391-4855
Practice Address - Fax:402-391-6818
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101284367500000X
NY665781367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered