MEDICARE: MRS. VANESSA SMITH NP

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	363LF0000X	Family Nurse Practitioner	95035756	CA

General Provider Information

NPI Number	:	1821989450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA SMITH NP

Provider Business Mailing Address
First Line	:	4523 PEBBLE BEACH DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1909
Country	:	US
Telephone Number	:	209-815-1976
Fax Number	:

Provider Business Practice Location Address
First Line	:	4523 PEBBLE BEACH DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1909
Country	:	US
Telephone Number	:	209-815-1976
Fax Number	:

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

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	07/11/2025

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