MEDICARE: MS. VANESSA MARIE REDD

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	RN.191152	OH

General Provider Information

NPI Number	:	1952605834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA MARIE REDD

Provider Business Mailing Address
First Line	:	25200 ROCKSIDE RD
Second Line	:	# 430
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1941
Country	:	US
Telephone Number	:	440-321-0358
Fax Number	:

Provider Business Practice Location Address
First Line	:	25200 ROCKSIDE RD
Second Line	:	# 430
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1941
Country	:	US
Telephone Number	:	440-321-0358
Fax Number	:

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

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	01/06/2011

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