MEDICARE: VANESSA LENNON RN

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	163WM0705X	Medical-Surgical Registered Nurse	9303530	FL
2	251B00000X	Case Management Agency
3	251E00000X	Home Health Agency
4	251J00000X	Nursing Care Agency
5	163W00000X	Registered Nurse	9303530	FL

General Provider Information

NPI Number	:	1508401803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA LENNON RN

Provider Business Mailing Address
First Line	:	4300 S JOG RD UNIT 541771
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-5078
Country	:	US
Telephone Number	:	561-247-4171
Fax Number	:

Provider Business Practice Location Address
First Line	:	6099 FARMERS PL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6501
Country	:	US
Telephone Number	:	954-643-1243
Fax Number	:

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

Provider Enumeration Date	:	11/10/2019
Last Update Date	:	11/10/2019

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