Provider Demographics
NPI:1063123834
Name:MILLER, VANESSA JANE (ARNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:JANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:JANE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:VANESSA HAZELTON
Mailing Address - Street 1:1182 NETTLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-7590
Mailing Address - Country:US
Mailing Address - Phone:702-493-0373
Mailing Address - Fax:
Practice Address - Street 1:1720 CENTRAL AVE E STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-1867
Practice Address - Country:US
Practice Address - Phone:641-456-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA172189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily