Provider Demographics
NPI:1831878974
Name:WEST, VANESSA ROSALES (APRN)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:ROSALES
Last Name:WEST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 RIDGEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7009
Mailing Address - Country:US
Mailing Address - Phone:706-273-8099
Mailing Address - Fax:
Practice Address - Street 1:310 GOLD CREEK TRL STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5436
Practice Address - Country:US
Practice Address - Phone:770-927-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN288956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily