Provider Demographics
NPI:1689963431
Name:PEDERSEN, VERONICA CAVELLA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:CAVELLA
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 DEYSHER RD
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9737
Mailing Address - Country:US
Mailing Address - Phone:610-987-0489
Mailing Address - Fax:
Practice Address - Street 1:154 DEYSHER RD
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-9737
Practice Address - Country:US
Practice Address - Phone:610-987-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000985171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist