Provider Demographics
NPI:1134551195
Name:VONADA, COURTNEY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANNE
Last Name:VONADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LAURELDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2661
Mailing Address - Country:US
Mailing Address - Phone:610-816-2060
Mailing Address - Fax:610-685-9290
Practice Address - Street 1:3212 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605-2661
Practice Address - Country:US
Practice Address - Phone:610-816-2060
Practice Address - Fax:610-685-9290
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056275363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA371095Medicare PIN