Provider Demographics
NPI:1619156890
Name:GREEN, VANESSA C (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:C
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:C
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1410 N. 8TH ST.
Mailing Address - Street 2:STE B
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-941-2500
Mailing Address - Fax:575-941-2503
Practice Address - Street 1:1410 N. 8TH ST
Practice Address - Street 2:STE B
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3212
Practice Address - Country:US
Practice Address - Phone:575-941-2500
Practice Address - Fax:575-941-2503
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily