Provider Demographics
NPI:1518619170
Name:WARD, VICTORIA DENICE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DENICE
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 BELVEDERE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-5418
Mailing Address - Country:US
Mailing Address - Phone:601-832-4419
Mailing Address - Fax:
Practice Address - Street 1:2318 BELVEDERE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-5418
Practice Address - Country:US
Practice Address - Phone:601-832-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider