Provider Demographics
NPI:1679163034
Name:GLAUDIN, VANESSA R (RN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:R
Last Name:GLAUDIN
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 1:39 STANDISH AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3840
Mailing Address - Country:US
Mailing Address - Phone:401-477-6947
Mailing Address - Fax:
Practice Address - Street 1:39 STANDISH AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3840
Practice Address - Country:US
Practice Address - Phone:401-477-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2344045163W00000X
RIRN66641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse