Provider Demographics
NPI:1184383895
Name:DUVERNE, VICTORIA LUCIANNE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LUCIANNE
Last Name:DUVERNE
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 1:3647 ELDER OAKS BLVD
Mailing Address - Street 2:4201
Mailing Address - City:NEW YORK
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:646-479-8489
Mailing Address - Fax:
Practice Address - Street 1:3647 ELDER OAKS BLVD APT 4201
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3399
Practice Address - Country:US
Practice Address - Phone:646-479-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse