Provider Demographics
NPI:1497190763
Name:BREEN, VANESSA LANGSTON (NP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LANGSTON
Last Name:BREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:CHRISTINA
Other - Last Name:LANGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2710 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3404
Mailing Address - Country:US
Mailing Address - Phone:650-364-6010
Mailing Address - Fax:650-298-6881
Practice Address - Street 1:2710 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3404
Practice Address - Country:US
Practice Address - Phone:650-364-6010
Practice Address - Fax:650-298-6881
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA790161163W00000X
CA22807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse