Provider Demographics
NPI:1730650003
Name:VASA, VANESSA RENE (RN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENE
Last Name:VASA
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 1:4568 GRAHAM CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-1578
Mailing Address - Country:US
Mailing Address - Phone:714-397-9132
Mailing Address - Fax:
Practice Address - Street 1:1107 S LEMAY AVE STE 300
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3955
Practice Address - Country:US
Practice Address - Phone:970-493-7442
Practice Address - Fax:970-493-2990
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0186003163W00000X
CO994462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse