Provider Demographics
NPI:1073285185
Name:VONDRAK, VICTORIA J (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:J
Last Name:VONDRAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 BARRETT STATION RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1606
Mailing Address - Country:US
Mailing Address - Phone:314-394-1923
Mailing Address - Fax:
Practice Address - Street 1:5650 MEXICO RD STE 2
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1696
Practice Address - Country:US
Practice Address - Phone:636-875-1270
Practice Address - Fax:636-875-1278
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021019401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily