Provider Demographics
NPI:1932362480
Name:MIRABBASI, VANESSA GAIL (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:GAIL
Last Name:MIRABBASI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SCHROEDER CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2526
Mailing Address - Country:US
Mailing Address - Phone:262-297-7246
Mailing Address - Fax:
Practice Address - Street 1:34 SCHROEDER CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2526
Practice Address - Country:US
Practice Address - Phone:262-297-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309906-031164W00000X
NVRN67831363LF0000X
WI14768-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse