Provider Demographics
NPI:1881218709
Name:MONTEITH, VANESSA LEIGH (LPN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEIGH
Last Name:MONTEITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CARVER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2111
Mailing Address - Country:US
Mailing Address - Phone:631-355-5980
Mailing Address - Fax:
Practice Address - Street 1:18 CARVER BLVD
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2111
Practice Address - Country:US
Practice Address - Phone:631-355-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY833046-01163W00000X
NY337938-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse