Provider Demographics
NPI:1912300807
Name:KLAUS, VANESSA M (FNP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:M
Last Name:KLAUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 E LEIGHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3061
Mailing Address - Country:US
Mailing Address - Phone:208-615-0322
Mailing Address - Fax:
Practice Address - Street 1:1294 E LEIGHFIELD DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3061
Practice Address - Country:US
Practice Address - Phone:208-615-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1508A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily