Provider Demographics
NPI:1699224022
Name:VICTORIN, DANISE
Entity Type:Individual
Prefix:
First Name:DANISE
Middle Name:
Last Name:VICTORIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 18TH ST
Mailing Address - Street 2:2-B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3745
Mailing Address - Country:US
Mailing Address - Phone:347-706-0897
Mailing Address - Fax:
Practice Address - Street 1:100 E 18TH ST
Practice Address - Street 2:2-B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3745
Practice Address - Country:US
Practice Address - Phone:347-706-0897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275378164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse