Provider Demographics
NPI:1609134006
Name:LAINE, VICTORIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:M
Last Name:LAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 W HORIZON RIDGE PKWY STE R204
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3600
Mailing Address - Country:US
Mailing Address - Phone:702-890-0292
Mailing Address - Fax:702-879-2891
Practice Address - Street 1:6 13TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5315
Practice Address - Country:US
Practice Address - Phone:406-883-5680
Practice Address - Fax:406-883-8910
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31865207R00000X
ALMD.38354207R00000X
CAA131124207R00000X
IAMD-46354207R00000X
MTMED-PHYS-LIC-77214207R00000X
IL036.150125207R00000X
ARE-9725207R00000X
MS26799207R00000X
IL036150125208M00000X
NV17435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist