MEDICARE: VANESSA A NORRIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	312862	LA

General Provider Information

NPI Number	:	1013478536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA A NORRIS MD

Provider Business Mailing Address
First Line	:	3909 LONG PRAIRIE RD BLDG 3
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1583
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 LONG PRAIRIE RD BLDG 3
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1583
Country	:	US
Telephone Number	:	504-568-4890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	05/29/2023

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