Provider Demographics
NPI:1972159432
Name:BUSSELL, VANESSA RHEANAL
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RHEANAL
Last Name:BUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 C ST S APT B51
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4598
Mailing Address - Country:US
Mailing Address - Phone:253-217-7035
Mailing Address - Fax:
Practice Address - Street 1:14207 C ST S APT B51
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4598
Practice Address - Country:US
Practice Address - Phone:253-217-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604430561374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty