Provider Demographics
NPI:1295549947
Name:PETERSON, VICTORIA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PETERSON
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 1:13888 GOODWIN ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-9107
Mailing Address - Country:US
Mailing Address - Phone:440-474-2772
Mailing Address - Fax:
Practice Address - Street 1:13888 GOODWIN ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:OH
Practice Address - Zip Code:44021-9107
Practice Address - Country:US
Practice Address - Phone:440-474-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker