Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | OS13622 | FL |
NPI | 1083900377 |
---|---|
Provider Name | Dr. Vanessa Joann Ohleyer |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 10/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022387400 | (05) | FL |
JE533Y | MEDICARE (01) | FL |