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General NPI Number Information
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NPI Number | 1023582665
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Entity Type | Individual
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Provider Name | VANESSA WANSEL CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 2193 EVERETT CT
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City | WALDORF
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State | MD
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Zip | 20601-5606
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Country | US
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Telephone | 301-535-8457
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Fax |
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Provider Business Mailing Address
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Address Line | 11415 ISAAC NEWTON SQ S
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City | RESTON
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State | VA
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Zip | 20190-5005
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Country | US
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Telephone | 751-489-4595
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Fax | 202-519-3494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R154907
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License Number State | MD
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