Provider Demographics
NPI:1922869825
Name:VICTOR, ANNA (RN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VICTOR
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 1:141 EL CAMINO LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2852
Mailing Address - Country:US
Mailing Address - Phone:917-370-1834
Mailing Address - Fax:
Practice Address - Street 1:141 EL CAMINO LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2852
Practice Address - Country:US
Practice Address - Phone:917-370-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713364163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse