Basic Information
| Provider Information | |||||||||
| NPI: | 1336498666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMOSS | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934546917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393474 | ||||||||
| FaxNumber: | 8053463548 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 W CENTRAL AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934362830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057354292 | ||||||||
| FaxNumber: | 8057354293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 21622 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 21622 | 01 | CA | CALIFORNIA BOARD OF REGISTERED NURSING FNP | OTHER |