Provider Demographics
NPI:1942909619
Name:CLYBURN, VICTORIA NICOLE BROOKE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NICOLE BROOKE
Last Name:CLYBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DELEWARE AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-859-2325
Mailing Address - Fax:
Practice Address - Street 1:310 DELEWARE AVE
Practice Address - Street 2:APT 5
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-859-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant