Provider Demographics
NPI:1619117488
Name:KNULL, VICTORIA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ANN
Last Name:KNULL
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 1:126 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-9509
Mailing Address - Country:US
Mailing Address - Phone:262-394-5011
Mailing Address - Fax:
Practice Address - Street 1:126 HOWARD ST
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9509
Practice Address - Country:US
Practice Address - Phone:262-394-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135228-030163W00000X
IL041-334607163W00000X
CA627828163W00000X
NY587658-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse