Provider Demographics
NPI:1891773164
Name:AINSWORTH, VICTORIA A (NP)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:A
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1250 S CLEARVIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3378
Mailing Address - Country:US
Mailing Address - Phone:480-988-9108
Mailing Address - Fax:480-813-4460
Practice Address - Street 1:40773 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7002
Practice Address - Country:US
Practice Address - Phone:602-714-1271
Practice Address - Fax:480-987-6566
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAP3947363LF0000X
CA14662363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ614020Medicaid
CAQ13567Medicare UPIN