Individual
MRS. VANESSA ANN NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM, RN
Contact information
Practice address
1379 W PARK WESTERN DR, #262, SAN PEDRO, CA 90732-2300
(310) 403-4415
Mailing address
1379 W PARK WESTERN DR, #262, SAN PEDRO, CA 90732-2300
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
724
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-043649
REGISTERED NURSE
AL
01
—
356899
RN LISCENSE
CA
01
—
724
CNM
CA
01
—
COAFS-06-387208
BPPVE CERTIFICATE
CA
Enumeration date
11/15/2006
Last updated
07/08/2014
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