Provider Demographics
NPI:1689847170
Name:NIGHTINGALE, VANESSA (LVN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9011
Mailing Address - Country:US
Mailing Address - Phone:209-221-2279
Mailing Address - Fax:
Practice Address - Street 1:401 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9011
Practice Address - Country:US
Practice Address - Phone:209-221-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 162307164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse