Provider Demographics
NPI:1912032913
Name:WYSZYNSKI, VICTORIA LYNN (PHD)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNN
Last Name:WYSZYNSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:TORI
Other - Middle Name:LYNN
Other - Last Name:WYSZYNSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:POST OFFICE 564
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:NM
Mailing Address - Zip Code:87527
Mailing Address - Country:US
Mailing Address - Phone:505-579-4009
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU
Practice Address - Street 2:BOX 6952
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6489
Practice Address - Country:US
Practice Address - Phone:505-758-5857
Practice Address - Fax:505-758-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist