MEDICARE: VANESSA ANN KING

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	163W00000X	Registered Nurse	221689-30	WI
2	367500000X	Certified Registered Nurse Anesthetist	209024885	IL

General Provider Information

NPI Number	:	1780263327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ANN KING

Provider Business Mailing Address
First Line	:	1009 N JACKSON ST APT 1904
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3264
Country	:	US
Telephone Number	:	920-636-8594
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 N JACKSON ST APT 1904
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3264
Country	:	US
Telephone Number	:	920-636-8594
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	03/25/2025

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Directions to “ VANESSA ANN KING ” Practice Location

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