Provider Demographics
NPI:1386448538
Name:BALLADARES, VANESSA ANDRIEUX (RN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANDRIEUX
Last Name:BALLADARES
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 ROBERT C DANIEL JR PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0803
Mailing Address - Country:US
Mailing Address - Phone:803-380-6180
Mailing Address - Fax:
Practice Address - Street 1:4735 RHETT DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3274
Practice Address - Country:US
Practice Address - Phone:954-673-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN333876163W00000X
FLRN9514352163W00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse