Provider Demographics
NPI:1588803209
Name:BROYLES, VANESSA (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:BROYLES
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GEORGE WALLACE DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-2270
Mailing Address - Country:US
Mailing Address - Phone:256-547-8653
Mailing Address - Fax:256-547-3513
Practice Address - Street 1:1100 GEORGE WALLACE DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-2270
Practice Address - Country:US
Practice Address - Phone:256-547-8653
Practice Address - Fax:256-547-3513
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-085020163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse