Provider Demographics
NPI:1649586785
Name:SKOCDOPOLE, VICTORIA CORRIN (APN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CORRIN
Last Name:SKOCDOPOLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:SKOCDOPOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:580 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4407
Mailing Address - Country:US
Mailing Address - Phone:775-786-4673
Mailing Address - Fax:775-348-2889
Practice Address - Street 1:580 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4407
Practice Address - Country:US
Practice Address - Phone:775-786-4673
Practice Address - Fax:775-348-2889
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001228363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001716086Medicaid