Provider Demographics
NPI:1720004252
Name:BASE-SMITH, VICTORIA GROOTEGOED (EX) (PHD,MSN, CRNA,CCRN)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:GROOTEGOED (EX)
Last Name:BASE-SMITH
Suffix:
Gender:F
Credentials:PHD,MSN, CRNA,CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 FIELDS ERTEL RD
Mailing Address - Street 2:
Mailing Address - City:SHARONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1761
Mailing Address - Country:US
Mailing Address - Phone:513-861-3100
Mailing Address - Fax:513-769-7709
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH RN689578367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered