Provider Demographics
NPI:1932746682
Name:MCGRODER, VANESSA (LPN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MCGRODER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 E MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9002
Mailing Address - Country:US
Mailing Address - Phone:440-413-1646
Mailing Address - Fax:
Practice Address - Street 1:5261 E MAPLE RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9002
Practice Address - Country:US
Practice Address - Phone:440-413-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135074164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse