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General NPI Number Information
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NPI Number | 1326869819
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Entity Type | Individual
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Provider Name | VANESSA VAZQUEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 2100 PFINGSTEN RD
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City | GLENVIEW
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State | IL
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Zip | 60026-1301
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Country | US
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Telephone | 847-570-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone | 224-730-9741
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085011007
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License Number State | IL
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