Provider Demographics
NPI:1871849067
Name:QUAVE, VANEESA M (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:VANEESA
Middle Name:M
Last Name:QUAVE
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 EVANGELINE ST.
Mailing Address - Street 2:P.O.BOX 327
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634
Mailing Address - Country:US
Mailing Address - Phone:337-463-4486
Mailing Address - Fax:337-462-2486
Practice Address - Street 1:216 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4251
Practice Address - Country:US
Practice Address - Phone:337-463-4486
Practice Address - Fax:337-462-2486
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN08555163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health