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General NPI Number Information
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NPI Number | 1720412356
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Entity Type | Individual
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Provider Name | SONDRA LEE VETOVITZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 1740 CLEVELAND RD
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City | WOOSTER
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State | OH
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Zip | 44691-2204
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Country | US
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Telephone | 330-287-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 205 PROSPECT ST
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City | LODI
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State | OH
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Zip | 44254-1431
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Country | US
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Telephone | 330-421-5623
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1110782
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License Number State | OH
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