Provider Demographics
NPI:1669142287
Name:DAMICO, VICTORIA (CNP, RN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:DAMICO
Suffix:
Gender:F
Credentials:CNP, RN
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:PIRRELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP, RN
Mailing Address - Street 1:492 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3816
Mailing Address - Country:US
Mailing Address - Phone:347-206-4772
Mailing Address - Fax:
Practice Address - Street 1:492 RICHARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3816
Practice Address - Country:US
Practice Address - Phone:347-206-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309609363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health