MEDICARE: DR. VANESSA SMITH BESTER PA

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	363A00000X	Physician Assistant	PA60342141	WA
2	363A00000X	Physician Assistant	4246	WI
3	363A00000X	Physician Assistant	12386	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750347043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA SMITH BESTER PA

Provider Business Mailing Address
First Line	:	425 20TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-4400
Country	:	US
Telephone Number	:	612-332-4973
Fax Number	:	612-238-3534

Provider Business Practice Location Address
First Line	:	425 20TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-4400
Country	:	US
Telephone Number	:	612-332-4973
Fax Number	:	612-238-3534

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	11/30/2022

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