Provider Demographics
NPI:1821750787
Name:GLENDENNING, VANESSA M (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:GLENDENNING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 E WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084-9421
Mailing Address - Country:US
Mailing Address - Phone:815-543-5887
Mailing Address - Fax:
Practice Address - Street 1:698 FEATHERSTONE RD STE 250
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6303
Practice Address - Country:US
Practice Address - Phone:815-399-4404
Practice Address - Fax:815-484-7058
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209024171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily