Healthcare Provider Details

I. General information

NPI: 1114465440
Provider Name (Legal Business Name): VANESSA LOUDERMILK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date: 02/26/2018
Reactivation Date: 09/13/2018

III. Provider practice location address

205 S PRATT AVE
CARSON CITY NV
89701-4730
US

IV. Provider business mailing address

205 S PRATT AVE
CARSON CITY NV
89701-4730
US

V. Phone/Fax

Practice location:
  • Phone: 775-882-3945
  • Fax:
Mailing address:
  • Phone: 775-882-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13571-C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: