Provider Demographics
NPI:1700494374
Name:MOE, VANESSA LYNN (NP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:MOE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:8804 N. 23RD AVENUE
Practice Address - Street 2:BLDG A, STE A01 & A02
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4160
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-216-7040
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ244749363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health