Provider Demographics
NPI:1568130789
Name:AMANOR, VANESSA DEDE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:DEDE
Last Name:AMANOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4053 NEVADA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1339
Mailing Address - Country:US
Mailing Address - Phone:651-208-2568
Mailing Address - Fax:
Practice Address - Street 1:4053 NEVADA AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1339
Practice Address - Country:US
Practice Address - Phone:651-208-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program