Provider Demographics
NPI:1962949289
Name:KANARR, VANESSA (DNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KANARR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:HARTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:9 HAWTHORNE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3194
Mailing Address - Country:US
Mailing Address - Phone:864-603-5600
Mailing Address - Fax:864-603-5601
Practice Address - Street 1:1300 SENTARA PARK # 3
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5884
Practice Address - Country:US
Practice Address - Phone:757-252-3050
Practice Address - Fax:864-603-5601
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174432363LF0000X
SC21913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21913OtherSC LICENSE
SCSCC9986586OtherMEDICARE PIN
SCSCC9985019OtherMEDICARE PIN