Provider Demographics
NPI:1821745035
Name:RUSSO, VICTORIA LUZ (RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LUZ
Last Name:RUSSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11007 73RD RD APT 6J
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6357
Mailing Address - Country:US
Mailing Address - Phone:347-806-5822
Mailing Address - Fax:
Practice Address - Street 1:11007 73RD RD APT 6J
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6357
Practice Address - Country:US
Practice Address - Phone:347-806-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474104163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool