Provider Demographics
NPI:1679114755
Name:PENDER, VICTORIA M (CRNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:PENDER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:M
Other - Last Name:PENDER-OKOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9840 SAPELO RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1807
Mailing Address - Country:US
Mailing Address - Phone:667-228-1735
Mailing Address - Fax:
Practice Address - Street 1:1232 RACE RD STE 403
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2386
Practice Address - Country:US
Practice Address - Phone:480-878-7806
Practice Address - Fax:443-732-0054
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172268363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health