Provider Demographics
NPI:1275002701
Name:CARTER, VICTORIA PRINCESS (FNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:PRINCESS
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 RAYMOND CT
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-8069
Mailing Address - Country:US
Mailing Address - Phone:847-515-1505
Mailing Address - Fax:847-515-1503
Practice Address - Street 1:176 W MOUND RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1964
Practice Address - Country:US
Practice Address - Phone:217-875-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.381119163W00000X
IL209.017759363LF0000X
IL209017759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily