Provider Demographics
NPI:1609398635
Name:RAZON, VANESSA TAPICERIA (APRN)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:TAPICERIA
Last Name:RAZON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:TAPICERIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:94-430 HAMAU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4507
Mailing Address - Country:US
Mailing Address - Phone:808-358-4400
Mailing Address - Fax:
Practice Address - Street 1:86-260 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3128
Practice Address - Country:US
Practice Address - Phone:808-697-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1739363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics