Provider Demographics
NPI:1811120140
Name:HARRELL, VANESSA RAESCHELLE (RN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAESCHELLE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1135
Mailing Address - Country:US
Mailing Address - Phone:617-698-8224
Mailing Address - Fax:
Practice Address - Street 1:1425 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2253
Practice Address - Country:US
Practice Address - Phone:617-296-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse