Provider Demographics
NPI:1417925579
Name:WOODBURY, VICTORIA THURSTON (ARNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:THURSTON
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 AVENUE O
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627
Mailing Address - Country:US
Mailing Address - Phone:319-372-9370
Mailing Address - Fax:319-372-8119
Practice Address - Street 1:5409 AVENUE O
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627
Practice Address - Country:US
Practice Address - Phone:319-372-9370
Practice Address - Fax:319-372-8119
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT04220364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
43547OtherIOWA HEALTH SOLUTIONS
42220OtherWELLMARK BCBS
9095OtherUBH MAIL HANDLERS BENEFIT
66200OtherIOWA HEALTH SOLUTIONS COM
13583OtherCOMPSYCH
234894OtherMIDLANDS CHOICE
13583OtherCOMPSYCH
S47368Medicare UPIN