Provider Demographics
NPI:1457419467
Name:GREEN, VANESSA J (WHCNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:GREEN
Suffix:
Gender:
Credentials:WHCNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:JOHNSON
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHCNP
Mailing Address - Street 1:5505 SPRING BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9250
Mailing Address - Country:US
Mailing Address - Phone:404-936-4936
Mailing Address - Fax:
Practice Address - Street 1:10432 PATRIOT HWY DEPT OF
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2628
Practice Address - Country:US
Practice Address - Phone:540-707-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019008363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q26288Medicare UPIN
50BBHVJMedicare ID - Type Unspecified