Provider Demographics
NPI:1952833253
Name:VANNERSON, ALEXIS KATHRYN (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:KATHRYN
Last Name:VANNERSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18650 NW CORNELL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9207
Mailing Address - Country:US
Mailing Address - Phone:503-848-5861
Mailing Address - Fax:503-848-5863
Practice Address - Street 1:18650 NW CORNELL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9207
Practice Address - Country:US
Practice Address - Phone:503-848-5861
Practice Address - Fax:503-848-5863
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201503446RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse