Provider Demographics
NPI:1700155538
Name:UNDERWOOD, VANESSA ANNE (PMHNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANNE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 DALLAS HWY NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3338
Mailing Address - Country:US
Mailing Address - Phone:971-915-2463
Mailing Address - Fax:503-990-6828
Practice Address - Street 1:4400 DALLAS HWY NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3338
Practice Address - Country:US
Practice Address - Phone:971-915-2463
Practice Address - Fax:503-990-6828
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150184NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health