Provider Demographics
NPI:1902216591
Name:JWAD, VANESSA AMEER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:AMEER
Last Name:JWAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:AMEER
Other - Last Name:NAJOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:37595 7 MILE RD
Mailing Address - Street 2:#400
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1003
Mailing Address - Country:US
Mailing Address - Phone:248-577-2570
Mailing Address - Fax:
Practice Address - Street 1:37595 7 MILE RD
Practice Address - Street 2:#400
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:248-577-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007467363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical