Provider Demographics
NPI:1609184589
Name:NYBO, VANESSA ROSE (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROSE
Last Name:NYBO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ROSE
Other - Last Name:DIPILATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:ATTN: MEDICAL STAFF SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-3110
Mailing Address - Fax:508-368-3113
Practice Address - Street 1:123 SUMMER ST STE 150S
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3110
Practice Address - Fax:508-368-3113
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN285114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner