Provider Demographics
NPI:1538490404
Name:FITZGERALD, VANESSA ELAINE (LVN)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ELAINE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 WRENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8583
Mailing Address - Country:US
Mailing Address - Phone:559-681-4480
Mailing Address - Fax:
Practice Address - Street 1:2652 WRENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8583
Practice Address - Country:US
Practice Address - Phone:559-681-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN173107164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse