Active NPI
Vanessa Ann Nicolas, CNM, RN
- Advanced Practice Midwife
- San Pedro, CA
National Provider Identifier
1053484428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- 724
- Practice address
- 1379 W Park Western Dr
#262
San Pedro, CA 90732-2300 - Phone
- (310) 403-4415
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 724 | CA | Primary |
Addresses
Primary practice location
1379 W Park Western Dr
#262
San Pedro, CA 90732-2300
Mailing address
1379 W Park Western Dr
#262
San Pedro, CA 90732-2300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 724 | Other | CA | CNM |
| COAFS-06-387208 | Other | CA | BPPVE CERTIFICATE |
| 356899 | Other | CA | RN LISCENSE |
| 1-043649 | Other | AL | REGISTERED NURSE |
Other names 1
- Ms. Vanessa Ann Iweka
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Midwife, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 724 | CA | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404777600000",
"number": "1053484428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1379 W PARK WESTERN DR",
"address_2": "#262",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907322300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1379 W PARK WESTERN DR",
"address_2": "#262",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907322300",
"telephone_number": "310-403-4415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAS",
"first_name": "VANESSA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "CNM, RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2014-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "CA",
"license": "724",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CNM",
"identifier": "724",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BPPVE CERTIFICATE",
"identifier": "COAFS-06-387208",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LISCENSE",
"identifier": "356899",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED NURSE",
"identifier": "1-043649",
"state": "AL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "VANESSA",
"last_name": "IWEKA",
"middle_name": "ANN",
"prefix": "MS.",
"credential": "CNM, RN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.