Modesta Vesonder, CRNP | |
4922 Lasalle Rd, Hyattsville, MD 20782-3302 | |
(301) 864-2333 | |
Not Available |
Full Name | Modesta Vesonder |
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Gender | Female |
Speciality | Nurse Practitioner - Adult Health |
Location | 4922 Lasalle Rd, Hyattsville, Maryland |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1245480557 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LA2200X | Nurse Practitioner - Adult Health | R136583 (Maryland) | Primary |
Entity Name | M Medical Group, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1780056168 PECOS PAC ID: 7719278597 Enrollment ID: O20200902001506 |
Mailing Address | Practice Location Address |
---|---|
Modesta Vesonder, CRNP 10204 Balsamwood Dr, Laurel, MD 20708-3154 Ph: (301) 604-7097 | Modesta Vesonder, CRNP 4922 Lasalle Rd, Hyattsville, MD 20782-3302 Ph: (301) 864-2333 |
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