| Doctor Name: | MRS. VANESSA WALDREP |
| NPI Number: | 1750653556 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | AC000987 |
| Business Practice Address: | 11908 Darnestown Rd Ste H North Potomac, MD - 208782295 |
| Business Phone Number: | 3019906333 |
| Business Fax Number: | |
| Mailing Address: | 11908 Darnestown Rd Ste H, NORTH POTOMAC |
| State: | MD |
| Postal Code: | 208782295 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/08/2012 |
| NPI Last Update Date: | 02/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | AC000987 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |