Provider Demographics
NPI:1952073223
Name:DIMURO, VANESSA (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DIMURO
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 1:95 E 7TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5767
Mailing Address - Country:US
Mailing Address - Phone:917-969-3722
Mailing Address - Fax:
Practice Address - Street 1:710 W 168TH ST # 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3726
Practice Address - Country:US
Practice Address - Phone:332-257-1279
Practice Address - Fax:212-305-1145
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily