Provider Demographics
NPI:1992524714
Name:BAIN, VANESSA DAWN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DAWN
Last Name:BAIN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 55TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4621
Mailing Address - Country:US
Mailing Address - Phone:806-292-2810
Mailing Address - Fax:
Practice Address - Street 1:4005 136TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2741
Practice Address - Country:US
Practice Address - Phone:972-754-9810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176468363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner