Provider Demographics
NPI:1629832704
Name:MAXSON, VANESSA FAITH
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:FAITH
Last Name:MAXSON
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 1:14087 NEFF RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8806
Mailing Address - Country:US
Mailing Address - Phone:810-627-8135
Mailing Address - Fax:
Practice Address - Street 1:14087 NEFF RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-8806
Practice Address - Country:US
Practice Address - Phone:810-627-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker