Provider Demographics
NPI:1063763670
Name:BLUDAU, VANESSA LYNN (RN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:LYNN
Last Name:BLUDAU
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Gender:F
Credentials:RN, FNP-C
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Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:PAV III STE#152
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-948-2076
Mailing Address - Fax:214-948-9990
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAV III STE#152
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-948-2076
Practice Address - Fax:214-948-9990
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2013-11-07
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Provider Licenses
StateLicense IDTaxonomies
TX720581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX893N77OtherBLUE CROSS
TX315549101Medicaid
TX273294YKQJMedicare PIN