Provider Demographics
NPI:1992375703
Name:GALES, VANESSA (LPN)
Entity Type:Individual
Prefix:PROF
First Name:VANESSA
Middle Name:
Last Name:GALES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47131-0616
Mailing Address - Country:US
Mailing Address - Phone:502-650-3851
Mailing Address - Fax:
Practice Address - Street 1:4405 BLACK SLATE CIR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8779
Practice Address - Country:US
Practice Address - Phone:502-650-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27049491A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty