Provider Demographics
NPI:1831340579
Name:HEINTZ, VICTORIA L (RN, LPCT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:RN, LPCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HIGH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2269
Mailing Address - Country:US
Mailing Address - Phone:503-657-0015
Mailing Address - Fax:
Practice Address - Street 1:615 HIGH ST
Practice Address - Street 2:SUITE E
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2269
Practice Address - Country:US
Practice Address - Phone:503-657-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OREPT-T-109075174400000X
OR079042335RN374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No374700000XNursing Service Related ProvidersTechnician