MEDICARE: VANESSA ATIE

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1518816875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ATIE

Provider Business Mailing Address
First Line	:	6742 AIRBORNE ST
Second Line	:
City	:	APO
State	:	AA
Zip	:	42223
Country	:	US
Telephone Number	:	570-814-9252
Fax Number	:

Provider Business Practice Location Address
First Line	:	6742 AIRBORNE ST
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223
Country	:	US
Telephone Number	:	570-814-9252
Fax Number	:

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

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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Directions to “ VANESSA ATIE ” Practice Location

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