Provider Demographics
NPI:1750679486
Name:NITIBHON, VANESSA A (MS)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:A
Last Name:NITIBHON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:A
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 NE 87TH AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664
Mailing Address - Country:US
Mailing Address - Phone:360-514-6060
Mailing Address - Fax:360-514-6074
Practice Address - Street 1:505 NE 87TH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-514-6060
Practice Address - Fax:360-514-6074
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS