Provider Demographics
NPI:1679818942
Name:VIVERETTE, VANESSA WHITE
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:WHITE
Last Name:VIVERETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:WHITE
Other - Last Name:VIVERETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP-FAMILY
Mailing Address - Street 1:7217 FLAME LEAF CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4093
Mailing Address - Country:US
Mailing Address - Phone:904-325-1344
Mailing Address - Fax:301-868-4575
Practice Address - Street 1:7955 TUCKERMAN LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-3243
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR110443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily