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General NPI Number Information
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NPI Number | 1124982798
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Entity Type | Organization
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Legal Business Name | MODESTA VESONDER CRNP LLC
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 7301 E FURNACE BRANCH RD
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City | GLEN BURNIE
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State | MD
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Zip | 21060-7059
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Country | US
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Telephone | 443-548-1708
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 E FURNACE BRANCH RD
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City | GLEN BURNIE
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State | MD
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Zip | 21060-7059
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MODESTA VESONDER
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Credential | CRNP
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Telephone | 301-875-1670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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