Provider Demographics
NPI:1770095853
Name:DEAN, VANESSA MARIE (ND)
Entity type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:MARIE
Last Name:DEAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 E FLOWER ST APT 256
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7350
Mailing Address - Country:US
Mailing Address - Phone:518-573-0877
Mailing Address - Fax:
Practice Address - Street 1:2401 N 24TH ST STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1836
Practice Address - Country:US
Practice Address - Phone:602-273-6888
Practice Address - Fax:518-573-0877
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ17-1676175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath