Provider Demographics
NPI:1043437775
Name:PAQUIN, VICTOR CONRAD (FPN)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:CONRAD
Last Name:PAQUIN
Suffix:
Gender:M
Credentials:FPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 S NC 16 HWY
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-1673
Mailing Address - Country:US
Mailing Address - Phone:828-330-2103
Mailing Address - Fax:704-325-0048
Practice Address - Street 1:1366 S NC 16 HWY
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-1673
Practice Address - Country:US
Practice Address - Phone:828-330-2103
Practice Address - Fax:704-325-0048
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC4079AMedicare PIN