MEDICARE: VANESSA FOGELBACH

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	APRN002137	NV

General Provider Information

NPI Number	:	1598125221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA FOGELBACH

Provider Business Mailing Address
First Line	:	3061 S MARYLAND PKWY STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6226
Country	:	US
Telephone Number	:	702-254-5437
Fax Number	:	702-254-7354

Provider Business Practice Location Address
First Line	:	3061 S MARYLAND PKWY STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6226
Country	:	US
Telephone Number	:	702-254-5437
Fax Number	:	702-254-7354

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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Directions to “ VANESSA FOGELBACH ” Practice Location

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