Provider Demographics
NPI:1790451516
Name:CAREY, VANESSA ROSE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROSE
Last Name:CAREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1420
Mailing Address - Country:US
Mailing Address - Phone:218-206-7252
Mailing Address - Fax:
Practice Address - Street 1:5272 FALCON DR
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1420
Practice Address - Country:US
Practice Address - Phone:218-206-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1109634253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency