Provider Demographics
NPI:1053961250
Name:CLOUD, VANESSA DIAZ
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DIAZ
Last Name:CLOUD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PLAINFIELD RD STE D
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7608
Mailing Address - Country:US
Mailing Address - Phone:630-277-9018
Mailing Address - Fax:866-531-8584
Practice Address - Street 1:535 PLAINFIELD RD STE D
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7608
Practice Address - Country:US
Practice Address - Phone:630-277-9018
Practice Address - Fax:866-531-8584
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-020062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner