Provider Demographics
NPI:1083394779
Name:RICIGLIANO, VICTOR VINCENT
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:VINCENT
Last Name:RICIGLIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOLVERTON
Mailing Address - State:MN
Mailing Address - Zip Code:56594-9586
Mailing Address - Country:US
Mailing Address - Phone:612-328-1639
Mailing Address - Fax:
Practice Address - Street 1:1874 17TH AVE N APT 11
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3165
Practice Address - Country:US
Practice Address - Phone:612-328-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant