Provider Demographics
NPI:1750347043
Name:BESTER, VANESSA SMITH (PA)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:SMITH
Last Name:BESTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-4400
Mailing Address - Country:US
Mailing Address - Phone:612-332-4973
Mailing Address - Fax:612-238-3534
Practice Address - Street 1:425 20TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-4400
Practice Address - Country:US
Practice Address - Phone:612-332-4973
Practice Address - Fax:612-238-3534
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60342141363A00000X
WI4246363A00000X
MN12386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA711913409AMedicaid
WA1750347043Medicaid
FL2916100-00Medicaid
FLP97199Medicare UPIN
FL2916100-00Medicaid
WA8943423Medicare PIN
WA1750347043Medicaid