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General NPI Number Information
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NPI Number | 1467418673
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Entity Type | Individual
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Provider Name | LISA LYNN VENDELAND D. O.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 115 PARKWAY OFFICE CT STE 104
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City | CARY
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State | NC
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Zip | 27518-7436
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Country | US
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Telephone | 919-851-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 2904 MILLS LAKE WYND
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-9741
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Country | US
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Telephone | 727-992-0707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2015-00767
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | OS8107
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License Number State | FL
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