Provider Demographics
NPI:1700295730
Name:KENDZIORA, VICTORIA LYNNE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNNE
Last Name:KENDZIORA
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 1:275 MAMMOTH RD., SUITE 3
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109
Mailing Address - Country:US
Mailing Address - Phone:603-663-8400
Mailing Address - Fax:603-663-8497
Practice Address - Street 1:275 MAMMOTH RD., SUITE 3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109
Practice Address - Country:US
Practice Address - Phone:603-663-8400
Practice Address - Fax:603-663-8497
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH044078-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily