MEDICARE: MRS. VANESSA DENNARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063135093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA DENNARD

Provider Business Mailing Address
First Line	:	PO BOX 45281
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87174-5281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 COORS BYP NW STE E1
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4055
Country	:	US
Telephone Number	:	505-677-0988
Fax Number	:	505-808-4942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	09/23/2022

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Directions to “ MRS. VANESSA DENNARD ” Practice Location

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