Provider Demographics
NPI:1982670204
Name:VEST, VICTORIA (CNM)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VEST
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CAMPUS DRIVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-885-8400
Mailing Address - Fax:207-885-8498
Practice Address - Street 1:96 CAMPUS DRIVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-885-8400
Practice Address - Fax:207-885-8498
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAM092001367A00000X
DCRN64841367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC466401900Medicaid
DC010189055Medicaid
DC466401900Medicaid
DC010189055Medicaid