Provider Demographics
NPI:1780603522
Name:CAIN, VANESSA S (FNP)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:S
Last Name:CAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 FAZIO DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7692
Mailing Address - Country:US
Mailing Address - Phone:910-558-7399
Mailing Address - Fax:919-654-9306
Practice Address - Street 1:929 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3331
Practice Address - Country:US
Practice Address - Phone:910-558-7399
Practice Address - Fax:919-654-9306
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201753207Q00000X
NC97858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMC1026372OtherDEA