Provider Demographics
NPI:1154088904
Name:STADEL, VANESSA R (NP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:R
Last Name:STADEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:R
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:629 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1807
Mailing Address - Country:US
Mailing Address - Phone:269-743-4129
Mailing Address - Fax:269-381-4050
Practice Address - Street 1:629 PIONEER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1807
Practice Address - Country:US
Practice Address - Phone:269-210-7566
Practice Address - Fax:269-381-4050
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286917363LF0000X, 363LC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health