Provider Demographics
NPI:1386463354
Name:LEAL, VANESSA MANALO (BSN RN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MANALO
Last Name:LEAL
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ESERJOSE
Other - Last Name:MANALO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2837 E TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1428
Mailing Address - Country:US
Mailing Address - Phone:650-296-3480
Mailing Address - Fax:
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-344-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN213488163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty