Healthcare Provider Details

I. General information

NPI: 1730097718
Provider Name (Legal Business Name): VICTORIA JOAN FRIEMARK-NELSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MONROE AVE
GREEN BAY WI
54301-4054
US

IV. Provider business mailing address

3117 PIONEER DR
GREEN BAY WI
54313-6136
US

V. Phone/Fax

Practice location:
  • Phone: 920-940-8016
  • Fax:
Mailing address:
  • Phone: 920-655-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3502-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: