Provider Demographics
NPI:1659678753
Name:KNOEDLER, VANESSA LARAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LARAINE
Last Name:KNOEDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15111 TWELVE OAKS CENTER DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5202
Practice Address - Country:US
Practice Address - Phone:952-993-4500
Practice Address - Fax:952-993-4639
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125053178207V00000X
MN54161207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology