Healthcare Provider Details

I. General information

NPI: 1629307442
Provider Name (Legal Business Name): VANESSA R. NORTH CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 06/17/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MDG, 331 SIJAN AVENUE
WHITEMAN AFB MO
65305
US

IV. Provider business mailing address

509 MDG, 331 SIJAN AVENUE
WHITEMAN AFB MO
65305
US

V. Phone/Fax

Practice location:
  • Phone: 660-687-2188
  • Fax:
Mailing address:
  • Phone: 660-687-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101071
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number15139
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: