Provider Demographics
NPI:1497998660
Name:KIZZIER-CARNAHAN, VANESSA RAE (DO)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:RAE
Last Name:KIZZIER-CARNAHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:RAE
Other - Last Name:KIZZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3355 RIVERBEND DR STE 240
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8800
Mailing Address - Country:US
Mailing Address - Phone:541-868-9273
Mailing Address - Fax:541-868-9497
Practice Address - Street 1:3355 RIVERBEND DR STE 240
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-868-9273
Practice Address - Fax:541-868-9497
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORPG156163207R00000X
ORDO158135207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine