Provider Demographics
NPI:1891977104
Name:VEGA, VERONICA I (MSN, FNP , PHN)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:I
Last Name:VEGA
Suffix:
Gender:F
Credentials:MSN, FNP , PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SOUTHAMPTON RD APT 159
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1816
Mailing Address - Country:US
Mailing Address - Phone:707-315-4094
Mailing Address - Fax:
Practice Address - Street 1:751 LOMBARDI CT STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5454
Practice Address - Country:US
Practice Address - Phone:707-479-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily