Provider Demographics
NPI:1265029516
Name:KROLIK, JUDI ANN (RN)
Entity type:Individual
Prefix:
First Name:JUDI
Middle Name:ANN
Last Name:KROLIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JUDI
Other - Middle Name:ANN
Other - Last Name:PATRONAGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:22 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW IPSWICH
Mailing Address - State:NH
Mailing Address - Zip Code:03071-3920
Mailing Address - Country:US
Mailing Address - Phone:540-871-4544
Mailing Address - Fax:
Practice Address - Street 1:655 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5714
Practice Address - Country:US
Practice Address - Phone:800-955-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH082006-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse