Provider Demographics
NPI:1073748240
Name:GRANDISON, VICTORIA (RN)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:GRANDISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108-08 FLATLANDS 8 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-581-8570
Mailing Address - Fax:718-763-7128
Practice Address - Street 1:108-08 FLATLANDS 8 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-581-8570
Practice Address - Fax:718-763-7128
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY710847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse