Provider Demographics
NPI:1457347643
Name:STUTZMAN, VICTORIA L (APRN)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:L
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 N WEBB RD
Mailing Address - Street 2:PO BOX 5346
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1743
Mailing Address - Country:US
Mailing Address - Phone:308-384-7625
Mailing Address - Fax:308-384-8904
Practice Address - Street 1:2337 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1743
Practice Address - Country:US
Practice Address - Phone:308-384-7625
Practice Address - Fax:308-384-8904
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110031363LP2300X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE276666Medicare PIN
NEP23046Medicare UPIN