Healthcare Provider Details

I. General information

NPI: 1659177210
Provider Name (Legal Business Name): VANESSA JEAN-LOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 SE MONTEREY RD APT A26
STUART FL
34994-4568
US

IV. Provider business mailing address

1021 SE MONTEREY RD APT A26
STUART FL
34994-4568
US

V. Phone/Fax

Practice location:
  • Phone: 772-900-6845
  • Fax: 772-324-5812
Mailing address:
  • Phone: 772-900-6845
  • Fax: 772-324-5812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number000000000
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: