Provider Demographics
NPI:1790143832
Name:STEADHAM, VANESSA ALANAH (BA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ALANAH
Last Name:STEADHAM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 EASTGATE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4080
Mailing Address - Country:US
Mailing Address - Phone:864-607-2374
Mailing Address - Fax:
Practice Address - Street 1:6600 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9001
Practice Address - Country:US
Practice Address - Phone:702-437-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1790143832225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner