Provider Demographics
NPI:1801008305
Name:MCCRORY, VANESSA IRENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:IRENE
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 N. LOCUST GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:208-338-5437
Mailing Address - Fax:208-939-9811
Practice Address - Street 1:3653 N. LOCUST GROVE ROAD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-338-5437
Practice Address - Fax:208-939-9811
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007712363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics