MEDICARE: VICTORIA MENNONA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP034522	PA

General Provider Information

NPI Number	:	1659236776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MENNONA FNP-BC

Provider Business Mailing Address
First Line	:	156 ASHFORD DR
Second Line	:
City	:	COOPERSBURG
State	:	PA
Zip	:	18036-3306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 ST LUKES BLVD # 230
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5665
Country	:	US
Telephone Number	:	484-526-2598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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