MEDICARE: VANESSA PRICE HAIRSTON NP

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	363LF0000X	Family Nurse Practitioner	0024097372	VA

General Provider Information

NPI Number	:	1295924538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA PRICE HAIRSTON NP

Provider Business Mailing Address
First Line	:	PO BOX 10399
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24543-5007
Country	:	US
Telephone Number	:	434-685-7095
Fax Number	:	434-685-2990

Provider Business Practice Location Address
First Line	:	4520 MEDICAL CENTER RD
Second Line	:
City	:	AXTON
State	:	VA
Zip	:	24054-2822
Country	:	US
Telephone Number	:	434-685-7095
Fax Number	:	434-685-2990

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

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	12/31/2019

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