Healthcare Provider Details

I. General information

NPI: 1427358597
Provider Name (Legal Business Name): TRESSIA VONDRAN R.N., L.M., C.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2010
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 VINE ST
JONESBORO AR
72401-3912
US

IV. Provider business mailing address

911 VINE ST
JONESBORO AR
72401-3912
US

V. Phone/Fax

Practice location:
  • Phone: 870-931-5903
  • Fax: 870-210-8780
Mailing address:
  • Phone: 870-931-5903
  • Fax: 870-210-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number042003
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: