Provider Demographics
NPI:1003426339
Name:BRENNECKE, VICTORIA A
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:BRENNECKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-0092
Mailing Address - Country:US
Mailing Address - Phone:978-571-9772
Mailing Address - Fax:
Practice Address - Street 1:2 NARROWS RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1677
Practice Address - Country:US
Practice Address - Phone:978-571-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist