Provider Demographics
NPI:1164102117
Name:ROLL, VANESSA MICHELE (NP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MICHELE
Last Name:ROLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:MICHELE
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:112 WEST SOUTH ST.
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:IN
Mailing Address - Zip Code:47042
Mailing Address - Country:US
Mailing Address - Phone:812-584-1555
Mailing Address - Fax:877-790-1165
Practice Address - Street 1:112 WEST SOUTH STREET
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042
Practice Address - Country:US
Practice Address - Phone:812-584-1555
Practice Address - Fax:877-790-1165
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015909A208D00000X
IN28172068A363LA2200X, 208D00000X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology