Provider Demographics
NPI:1790186351
Name:MALOTT, VANESSA RENE (RN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENE
Last Name:MALOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:RENE
Other - Last Name:FAJARDO-LOZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:701 W 101ST PL S APT 815
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3546
Mailing Address - Country:US
Mailing Address - Phone:619-340-6291
Mailing Address - Fax:
Practice Address - Street 1:701 W 101ST PL S APT 815
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3546
Practice Address - Country:US
Practice Address - Phone:619-340-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205821163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse