Provider Demographics
NPI:1740506203
Name:SLOTS, VANESSA ELENE (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ELENE
Last Name:SLOTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ELENE
Other - Last Name:LESHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9900 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3609
Mailing Address - Country:US
Mailing Address - Phone:651-471-5800
Mailing Address - Fax:651-471-5801
Practice Address - Street 1:9900 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3609
Practice Address - Country:US
Practice Address - Phone:651-471-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14786208000000X
MN72987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1740506203Medicaid
12516011OtherCAQH