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NPI Code Detail

MEDICARE: NICOLE LEIGH VONDALL P.A.

MEDICARE: NICOLE LEIGH VONDALL P.A.
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
1363A00000XPhysician Assistant1090664TX
2363A00000XPhysician AssistantPA07531TX

General Provider Information

NPI Number : 1780913574
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LEIGH VONDALL P.A.
Provider Business Mailing Address
First Line : 11300 N LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78753-2665
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11300 N LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78753-2665
Country : US
Telephone Number : 512-835-6751
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2009
Last Update Date : 12/03/2019

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Directions to “ NICOLE LEIGH VONDALL P.A.” Practice Location

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