Provider Demographics
NPI:1851931315
Name:WINGERATH, VANESSA LILLIE (CD(DONA))
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LILLIE
Last Name:WINGERATH
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 E MALVERN ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5613
Mailing Address - Country:US
Mailing Address - Phone:347-461-4459
Mailing Address - Fax:
Practice Address - Street 1:2634 E MALVERN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5613
Practice Address - Country:US
Practice Address - Phone:347-461-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12766374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula