Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | NC3013 | NC |
NPI | 1033136122 |
---|---|
Provider Name | Jon Michael Vezendy |
First Address | Cornelius, NC 28031-6399 |
Second Address | Cornelius, NC 28031-6399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 02/07/2019 |