Provider Demographics
NPI:1548937758
Name:MONSEF, VANESSA NICHOLLE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICHOLLE
Last Name:MONSEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 NE 63RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0208
Mailing Address - Country:US
Mailing Address - Phone:360-521-0482
Mailing Address - Fax:
Practice Address - Street 1:100 E 33RD ST STE 206
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2776
Practice Address - Country:US
Practice Address - Phone:360-695-1334
Practice Address - Fax:360-707-7453
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202100197NP-PP363L00000X
WAAP61128481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2203045Medicaid