Provider Demographics
NPI:1083938021
Name:WILLIAMS, VICTORIA LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNNE
Last Name:WILLIAMS
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 1:18110 NW CORNELL RD
Mailing Address - Street 2:APT. B
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8657
Mailing Address - Country:US
Mailing Address - Phone:503-747-0866
Mailing Address - Fax:
Practice Address - Street 1:18110 NW CORNELL RD
Practice Address - Street 2:APT. B
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8657
Practice Address - Country:US
Practice Address - Phone:503-747-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR077009450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse