Provider Demographics
NPI:1598125957
Name:DODSON, VANESSA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:DODSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NORD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1839
Mailing Address - Country:US
Mailing Address - Phone:631-413-8277
Mailing Address - Fax:
Practice Address - Street 1:19 NORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1839
Practice Address - Country:US
Practice Address - Phone:631-413-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-28
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse