1659882900 NPI number — MRS. VANESSA INES MOLINA PEREZ FNP-C

Table of content: MRS. VANESSA INES MOLINA PEREZ FNP-C (NPI 1659882900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659882900 NPI number — MRS. VANESSA INES MOLINA PEREZ FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLINA PEREZ
Provider First Name:
VANESSA
Provider Middle Name:
INES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659882900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28779-0360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-339-6065
Provider Business Mailing Address Fax Number:
828-692-2487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 6TH AVE W STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28739-4160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-692-8045
Provider Business Practice Location Address Fax Number:
828-692-6630
Provider Enumeration Date:
10/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  5009957 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 5009957 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6582443 . This is a "UHC (LFM)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P02131511 . This is a "RAILROAD MEDICARE PTAN(LFM)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NCZ926B . This is a "MEDICARE PTAN(LFM)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 19TJJ . This is a "BCBS NC(LFM)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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