Provider Demographics
NPI:1063133429
Name:ROOF, VANESSA LAUREN (NP)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LAUREN
Last Name:ROOF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16789 E 400 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:HEYWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:61745-9046
Mailing Address - Country:US
Mailing Address - Phone:309-336-2249
Mailing Address - Fax:
Practice Address - Street 1:5600 N GLEN ELM DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4340
Practice Address - Country:US
Practice Address - Phone:844-341-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025865207QG0300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine