Provider Demographics
NPI:1750797338
Name:HANNICK, VANESSA CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:CATHERINE
Last Name:HANNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:CATHERINE HANNICK
Other - Last Name:SIEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2747 BOYS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-5004
Mailing Address - Country:US
Mailing Address - Phone:540-840-3201
Mailing Address - Fax:
Practice Address - Street 1:7261 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2311
Practice Address - Country:US
Practice Address - Phone:402-398-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE29085207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program