Individual
MARY LELA VALENTINE VONDER HAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2222 JACKSON AVE W, OXFORD, MS 38655-5409
(662) 380-5560
Mailing address
2222 JACKSON AVE W, OXFORD, MS 38655-5409
(662) 380-5560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00685
MS
363A00000X
Physician Assistant
PA12044
TX
Other
Enumeration date
09/27/2017
Last updated
05/09/2023
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