Provider Demographics
NPI:1033293212
Name:LONCZYNSKI, VICTORIA M (CRNA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:LONCZYNSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 FLAMINGO ST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4132
Mailing Address - Country:US
Mailing Address - Phone:810-794-1428
Mailing Address - Fax:
Practice Address - Street 1:14500 HALL RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1229
Practice Address - Country:US
Practice Address - Phone:586-247-6918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704171239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered