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General NPI Number Information
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NPI Number | 1003399510
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Entity Type | Individual
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Provider Name | JUSTINA JANE VOLODZKO PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 1 ELLIOT WAY
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City | MANCHESTER
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State | NH
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Zip | 03103-3599
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Country | US
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Telephone | 603-669-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 25 GLACIER WAY
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City | MANCHESTER
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State | NH
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Zip | 03109-5100
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Country | US
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Telephone | 203-470-2154
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | NH
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