Provider Demographics
NPI:1720395650
Name:STEWART, VANESSA PEARL (RN)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:PEARL
Last Name:STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:PEARL
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:657 N TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6367
Mailing Address - Country:US
Mailing Address - Phone:702-233-7787
Mailing Address - Fax:
Practice Address - Street 1:657 N TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6367
Practice Address - Country:US
Practice Address - Phone:702-233-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN25654163WN0002X
NVAPN001262363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care