Individual
JESSICA M VANDERHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
513 3RD ST SW, WAGNER, SD 57380-9675
(605) 384-3611
Mailing address
6915 VILLAGE MEDICAL CIR, CLEMMONS, NC 27012-8002
(336) 893-1000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5017905
NC
363LF0000X
Family Nurse Practitioner
CP001277
SD
Other
Enumeration date
09/26/2017
Last updated
04/16/2024
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