Healthcare Provider Details

I. General information

NPI: 1265029516
Provider Name (Legal Business Name): JUDI ANN KROLIK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDI ANN PATRONAGIO RN

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S WILLOW ST
MANCHESTER NH
03103-5714
US

IV. Provider business mailing address

22 VALLEY RD
NEW IPSWICH NH
03071-3920
US

V. Phone/Fax

Practice location:
  • Phone: 800-955-2673
  • Fax:
Mailing address:
  • Phone: 540-871-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number082006-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: