MEDICARE: VANESSA DARNELL NP-C

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	AK1168	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	481159633	OTHER	KS	ETIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679806137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA DARNELL NP-C

Provider Business Mailing Address
First Line	:	2370 CORPORATE CIR STE 300
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7760
Country	:	US
Telephone Number	:	702-910-3950
Fax Number	:

Provider Business Practice Location Address
First Line	:	272 NW MEDICAL LOOP STE B
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5545
Country	:	US
Telephone Number	:	541-537-8007
Fax Number	:

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

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	02/04/2022

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