Provider Demographics
NPI:1235134925
Name:PEREZ WEISS, VANESSA M (FNP, NP-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:PEREZ WEISS
Suffix:
Gender:F
Credentials:FNP, NP-C
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:M
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1210 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-2016
Mailing Address - Country:US
Mailing Address - Phone:484-408-0755
Mailing Address - Fax:484-408-0755
Practice Address - Street 1:1210 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-2016
Practice Address - Country:US
Practice Address - Phone:484-408-0755
Practice Address - Fax:484-408-0756
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091035Medicare ID - Type Unspecified
PAQ43816Medicare UPIN