Provider Demographics
NPI:1659080752
Name:SOTO, VANESA MATTIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:VANESA
Middle Name:MATTIE
Last Name:SOTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 N DUNTON AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5980
Mailing Address - Country:US
Mailing Address - Phone:224-628-0612
Mailing Address - Fax:
Practice Address - Street 1:863 N MILWAUKEE AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1643
Practice Address - Country:US
Practice Address - Phone:224-628-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041503062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse