Provider Demographics
NPI:1427358597
Name:VONDRAN, TRESSIA (RN, LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:TRESSIA
Middle Name:
Last Name:VONDRAN
Suffix:
Gender:F
Credentials:RN, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 VINE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3912
Mailing Address - Country:US
Mailing Address - Phone:870-931-5903
Mailing Address - Fax:870-210-8780
Practice Address - Street 1:911 VINE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3912
Practice Address - Country:US
Practice Address - Phone:870-931-5903
Practice Address - Fax:870-210-8780
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR042003176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife