Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 5053 | NV |
NPI | 1891045159 |
---|---|
Provider Name | Anne Vondruska |
First Address | Gardnerville, NV 89410-5270 |
Second Address | Gardnerville, NV 89410-5270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 13/09/2012 |