Provider Demographics
NPI:1578189601
Name:MOHRBACHER, VANESSA NOREEN (FNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:NOREEN
Last Name:MOHRBACHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:NOREEN
Other - Last Name:FRIESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:150 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-3233
Mailing Address - Country:US
Mailing Address - Phone:541-435-7200
Mailing Address - Fax:541-888-0025
Practice Address - Street 1:150 S WALL ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3233
Practice Address - Country:US
Practice Address - Phone:541-435-7200
Practice Address - Fax:541-888-0025
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORF06201881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500782211Medicaid