Healthcare Provider Details

I. General information

NPI: 1134551195
Provider Name (Legal Business Name): COURTNEY ANNE VONADA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 KUTZTOWN RD
LAURELDALE PA
19605-2661
US

IV. Provider business mailing address

3212 KUTZTOWN RD
LAURELDALE PA
19605-2661
US

V. Phone/Fax

Practice location:
  • Phone: 610-816-2060
  • Fax: 610-685-9290
Mailing address:
  • Phone: 610-816-2060
  • Fax: 610-685-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056275
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: