Provider Demographics
NPI:1821351891
Name:VISSER, TESSA VANESSA BANDHAN (MD)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:VANESSA BANDHAN
Last Name:VISSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1106 SAINT MARYS RD STE 309
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4845
Mailing Address - Country:US
Mailing Address - Phone:785-238-4131
Mailing Address - Fax:785-210-3448
Practice Address - Street 1:1110 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4176
Practice Address - Country:US
Practice Address - Phone:785-762-2585
Practice Address - Fax:785-210-3448
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-40302208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics