Provider Demographics
NPI:1073857645
Name:CLAIRE, VICTORIA M (RN)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:M
Last Name:CLAIRE
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 1:80 GIBBS POND RD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2258
Mailing Address - Country:US
Mailing Address - Phone:631-724-4491
Mailing Address - Fax:
Practice Address - Street 1:80 GIBBS POND RD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2258
Practice Address - Country:US
Practice Address - Phone:631-724-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654454163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse