Provider Demographics
NPI:1952034266
Name:LOE, VANESSA RUTH (STUDENT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RUTH
Last Name:LOE
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 CIRCLE BLUFF TRL
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-7274
Mailing Address - Country:US
Mailing Address - Phone:715-415-3657
Mailing Address - Fax:
Practice Address - Street 1:3033 CIRCLE BLUFF TRL
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-7274
Practice Address - Country:US
Practice Address - Phone:715-415-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program