Provider Demographics
NPI:1205047040
Name:VORIES, VONETTA M (FNP-C)
Entity type:Individual
Prefix:
First Name:VONETTA
Middle Name:M
Last Name:VORIES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1514
Mailing Address - Country:US
Mailing Address - Phone:812-385-1071
Mailing Address - Fax:812-385-8793
Practice Address - Street 1:314 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1514
Practice Address - Country:US
Practice Address - Phone:812-385-1071
Practice Address - Fax:812-385-8793
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001190A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201092760BOtherMEDICAID GROUP
IN258190OtherGROUP MEDICARE NUMBER
IN200922190OtherGROUP MEDICAID NUMBER
IN200884570Medicaid
IN201092760BOtherMEDICAID GROUP
INP49700Medicare UPIN