Provider Demographics
NPI:1063022366
Name:GOLDEN, VICTORIA LEE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3344
Mailing Address - Country:US
Mailing Address - Phone:219-359-0803
Mailing Address - Fax:
Practice Address - Street 1:1925 TULIP LN
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3241
Practice Address - Country:US
Practice Address - Phone:219-359-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041237171163WL0100X
IN28160367A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28160367AOtherINDIANA DEPARTMENT OF REGULATION NURSING BOARD
L-18631OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS
IL041237171OtherILLINOIS DEPARTMENT OF REGULATION NURSING BOARD