Provider Demographics
NPI:1265698708
Name:MCCREERY, VANESSA MARIE (LPT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:MCCREERY
Suffix:
Gender:F
Credentials:LPT
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12141 BROOKHURST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2865
Mailing Address - Country:US
Mailing Address - Phone:657-261-7140
Mailing Address - Fax:714-922-1032
Practice Address - Street 1:23161 MILL CREEK DR STE 230
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7935
Practice Address - Country:US
Practice Address - Phone:949-264-5350
Practice Address - Fax:949-221-6939
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 18973167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT 18973OtherCALIFORNIA, BOARD OF VOCATIONAL NURSES AND PSYCHIATRIC TECHNICIAN EXAMINERS