Healthcare Provider Details

I. General information

NPI: 1437743739
Provider Name (Legal Business Name): VANESSA MARIE PURSEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS JOHN C. STENNIS (CVN-74) UNIT 100175 BOX 1
FPO AE
09512
US

IV. Provider business mailing address

USS JOHN C. STENNIS (CVN-74) UNIT 100175 BOX 1
FPO AE
09512
US

V. Phone/Fax

Practice location:
  • Phone: 702-279-3061
  • Fax:
Mailing address:
  • Phone: 702-279-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12271407-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: