Provider Demographics
NPI:1932362480
Name:MIRABBASI, VANESSA GAIL (NP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:GAIL
Last Name:MIRABBASI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 AMIGO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1210
Mailing Address - Country:US
Mailing Address - Phone:702-380-8300
Mailing Address - Fax:702-380-8302
Practice Address - Street 1:8025 AMIGO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1210
Practice Address - Country:US
Practice Address - Phone:702-380-8300
Practice Address - Fax:702-380-8302
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309906-031164W00000X
NVRN67831363LF0000X
NV832621363LF0000X, 363L00000X
WI14768-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner