Provider Demographics
NPI:1861454068
Name:STYNINGER, VICTORIA D (PA)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:D
Last Name:STYNINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:D
Other - Last Name:CASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:PO BOX 680
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529
Mailing Address - Country:US
Mailing Address - Phone:309-742-2921
Mailing Address - Fax:309-742-8411
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529
Practice Address - Country:US
Practice Address - Phone:309-742-2921
Practice Address - Fax:309-742-8411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P55073Medicare UPIN
208234Medicare ID - Type Unspecified