Provider Demographics
NPI:1437811445
Name:INCOOM, VICTORIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:INCOOM
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 1:9332 OLD SCAGGSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1732
Mailing Address - Country:US
Mailing Address - Phone:443-831-4622
Mailing Address - Fax:301-490-2353
Practice Address - Street 1:9332 OLD SCAGGSVILLE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1732
Practice Address - Country:US
Practice Address - Phone:443-831-4622
Practice Address - Fax:301-490-2353
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13AL0299-A310400000X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility