Provider Demographics
NPI:1609285410
Name:BOXBERGER, VICTORIA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:BOXBERGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TEDDY BEAR LN
Mailing Address - Street 2:
Mailing Address - City:SWAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12783-6031
Mailing Address - Country:US
Mailing Address - Phone:845-796-6073
Mailing Address - Fax:
Practice Address - Street 1:15 TEDDY BEAR LN
Practice Address - Street 2:
Practice Address - City:SWAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12783-6031
Practice Address - Country:US
Practice Address - Phone:845-796-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252781-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse