Provider Demographics
NPI:1851573356
Name:TOMMY, VONJO RANDOLPH (RN)
Entity Type:Individual
Prefix:MR
First Name:VONJO
Middle Name:RANDOLPH
Last Name:TOMMY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7390 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8497
Mailing Address - Country:US
Mailing Address - Phone:610-928-7306
Mailing Address - Fax:
Practice Address - Street 1:7390 PIONEER DR
Practice Address - Street 2:SUITE 1ST FLOOR
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8497
Practice Address - Country:US
Practice Address - Phone:917-753-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse