Provider Demographics
NPI:1467039578
Name:HASE, VICTORIA LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYNNE
Last Name:HASE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:LYNNE
Other - Last Name:WYLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7774 DAYTON SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-1957
Mailing Address - Country:US
Mailing Address - Phone:937-864-7363
Mailing Address - Fax:
Practice Address - Street 1:7774 DAYTON SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-1957
Practice Address - Country:US
Practice Address - Phone:937-864-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006541RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant