Healthcare Provider Details

I. General information

NPI: 1427014406
Provider Name (Legal Business Name): VANESSA MIX
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST ST VINCENTS MEDICAL CENTER
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

4 ARMSTRONG ROAD
SHELTON CT
06484
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-7353
  • Fax:
Mailing address:
  • Phone: 203-929-7353
  • Fax: 203-929-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number003193
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: