MEDICARE: MRS. RHONDA VEDDER DESSERT NURSE PRACITITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95004946	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95004946	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1649763665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA VEDDER DESSERT NURSE PRACITITIONER

Provider Business Mailing Address
First Line	:	516 W ATEN RD
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-9805
Country	:	US
Telephone Number	:	760-355-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 N IMPERIAL AVE STE 2
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-6304
Country	:	US
Telephone Number	:	760-353-5888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	06/13/2018

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