Provider Demographics
NPI:1306136924
Name:VONDRA, VANESSA NICOLE (RN)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:NICOLE
Last Name:VONDRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 REDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6226
Mailing Address - Country:US
Mailing Address - Phone:907-488-9458
Mailing Address - Fax:
Practice Address - Street 1:3515 REDSTONE RD
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-6226
Practice Address - Country:US
Practice Address - Phone:907-488-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26789163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical