Provider Demographics
NPI:1457970188
Name:DWAIRI, VANESSA FARES
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:FARES
Last Name:DWAIRI
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 1:120 E SECOND ST 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1578
Mailing Address - Country:US
Mailing Address - Phone:412-647-5815
Mailing Address - Fax:
Practice Address - Street 1:120 E SECOND ST 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1578
Practice Address - Country:US
Practice Address - Phone:412-647-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program