Healthcare Provider Details

I. General information

NPI: 1093936247
Provider Name (Legal Business Name): JOSHUA ANDRE VENDIG FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 N TU SU LN
BISHOP CA
93514-8058
US

IV. Provider business mailing address

52 N TU SU LN
BISHOP CA
93514-8058
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-8461
  • Fax: 760-873-3908
Mailing address:
  • Phone: 760-873-8461
  • Fax: 760-873-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: