Provider Demographics
NPI:1689323412
Name:ANDERSEN, VICTORIA HONORINE I (BUSINESS OWNER (CNA))
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:HONORINE
Last Name:ANDERSEN
Suffix:I
Gender:F
Credentials:BUSINESS OWNER (CNA)
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:HONORINE
Other - Last Name:ANDERSEN
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24386 STATE HIGHWAY RA
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:MO
Mailing Address - Zip Code:65658-8423
Mailing Address - Country:US
Mailing Address - Phone:417-846-8485
Mailing Address - Fax:
Practice Address - Street 1:24386 STATE HIGHWAY RA
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:MO
Practice Address - Zip Code:65658-8423
Practice Address - Country:US
Practice Address - Phone:417-846-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114550A376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide