Provider Demographics
NPI:1669075404
Name:WALLENHORST, VANESSA MORGAN
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MORGAN
Last Name:WALLENHORST
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 1:22624 ROAD R
Mailing Address - Street 2:
Mailing Address - City:FORT JENNINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45844-9145
Mailing Address - Country:US
Mailing Address - Phone:419-979-9047
Mailing Address - Fax:
Practice Address - Street 1:22624 ROAD R
Practice Address - Street 2:
Practice Address - City:FORT JENNINGS
Practice Address - State:OH
Practice Address - Zip Code:45844-9145
Practice Address - Country:US
Practice Address - Phone:419-979-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care