Provider Demographics
NPI:1770611840
Name:FEGLEY, VANESSA MELANIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MELANIE
Last Name:FEGLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 MERKLE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7173
Mailing Address - Country:US
Mailing Address - Phone:740-383-2449
Mailing Address - Fax:614-440-3086
Practice Address - Street 1:942 MERKLE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7173
Practice Address - Country:US
Practice Address - Phone:740-383-2449
Practice Address - Fax:614-440-3086
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-081684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270395Medicaid