Provider Demographics
NPI:1164655742
Name:VERVYNCK, JOANNE
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:VERVYNCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 BRAZOS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4020
Mailing Address - Country:US
Mailing Address - Phone:940-452-4190
Mailing Address - Fax:940-521-9465
Practice Address - Street 1:1309 BRAZOS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4020
Practice Address - Country:US
Practice Address - Phone:940-452-4190
Practice Address - Fax:940-521-9465
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies