Healthcare Provider Details

I. General information

NPI: 1003746850
Provider Name (Legal Business Name): VANESSA LANDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 114
CANVAS WV
26662-0114
US

IV. Provider business mailing address

PO BOX 114
CANVAS WV
26662-0114
US

V. Phone/Fax

Practice location:
  • Phone: 681-313-4759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN121631
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: