Provider Demographics
NPI:1144094582
Name:VICKY LOLO A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:VICKY LOLO A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMERI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:415-449-5097
Mailing Address - Street 1:2323 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2414
Mailing Address - Country:US
Mailing Address - Phone:415-449-5097
Mailing Address - Fax:
Practice Address - Street 1:2323 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2414
Practice Address - Country:US
Practice Address - Phone:415-449-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty