Provider Demographics
NPI:1780263327
Name:KING, VANESSA ANN
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:KING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N JACKSON ST APT 1904
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3264
Mailing Address - Country:US
Mailing Address - Phone:920-636-8594
Mailing Address - Fax:
Practice Address - Street 1:1009 N JACKSON ST APT 1904
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3264
Practice Address - Country:US
Practice Address - Phone:920-636-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI221689-30163W00000X
IL209024885367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse