Provider Demographics
NPI:1821189549
Name:PITCHFORD, VICTORIA LYNN (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:PITCHFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9894 EAST 121ST STREET
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-0000
Mailing Address - Country:US
Mailing Address - Phone:317-621-4800
Mailing Address - Fax:317-621-4700
Practice Address - Street 1:7229 CLEARVISTA DRIVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1698
Practice Address - Country:US
Practice Address - Phone:317-621-4300
Practice Address - Fax:317-621-4301
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001931A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200544800Medicaid
IN000000589901OtherANTHEM
INP01170029OtherRR MEDICARE PTAN
IN234020DMedicare PIN
INP01170029OtherRR MEDICARE PTAN
IN940510R4Medicare ID - Type Unspecified