Provider Demographics
NPI:1063617694
Name:KONRADSON, VICTORIA LEE (LPN DM)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEE
Last Name:KONRADSON
Suffix:
Gender:F
Credentials:LPN DM
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN DM
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:HEART N HANDS MIDWIFERY
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0087
Mailing Address - Country:US
Mailing Address - Phone:541-390-2999
Mailing Address - Fax:
Practice Address - Street 1:3221 SW 45TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9519
Practice Address - Country:US
Practice Address - Phone:541-390-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080011712LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR18235OtherOREGON BOARD OF MASSAGE THERAPISTS