Provider Demographics
NPI:1063015279
Name:ROULIER, VICTORIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ROULIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 SOMERSET VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CANE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4488
Mailing Address - Country:US
Mailing Address - Phone:423-544-5229
Mailing Address - Fax:
Practice Address - Street 1:2220 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0021
Practice Address - Country:US
Practice Address - Phone:615-936-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000193909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse