| Organization Name: | VANESSA FOWLKES NP LLC |
| NPI Number: | 1083906804 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VANESSA PEYTON FOWLKES (OWNER) |
| Mailing Address: | 2447 Crowncrest Dr Henrico |
| State: | VA US |
| Postal Code: | 232332517 |
| Phone Number: | 8044059448 |
| Fax Number: | 8044822830 |
| NPI Enumeration Date: | 05/12/2011 |
| NPI Last Update Date: | 05/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | 0024164743 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |