Healthcare Provider Details

I. General information

NPI: 1063617694
Provider Name (Legal Business Name): VICTORIA LEE KONRADSON LPN DM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA LEE SHEA LPN DM

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 SW 45TH ST
REDMOND OR
97756-9519
US

IV. Provider business mailing address

PO BOX 454 HEART N HANDS MIDWIFERY
REDMOND OR
97756-0087
US

V. Phone/Fax

Practice location:
  • Phone: 541-390-2999
  • Fax:
Mailing address:
  • Phone: 541-390-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number080011712LPN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: