Provider Demographics
NPI:1023582665
Name:WANSEL, VANESSA (CRNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:WANSEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 ISAAC NEWTON SQ S
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5005
Mailing Address - Country:US
Mailing Address - Phone:751-489-4595
Mailing Address - Fax:202-519-3494
Practice Address - Street 1:2193 EVERETT CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-5606
Practice Address - Country:US
Practice Address - Phone:301-535-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner