Provider Demographics
NPI:1841255213
Name:VICTOR, LORRAINE C (CNNP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:C
Last Name:VICTOR
Suffix:
Gender:F
Credentials:CNNP
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:C
Other - Last Name:DRIMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNNP
Mailing Address - Street 1:2910 CENTRE POINTE DRIVE 35121A
Mailing Address - Street 2:CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVENUE
Practice Address - Street 2:CHILDRENS SPECIALITY CLINIC NICU
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6210
Practice Address - Fax:651-220-7777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0779441363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Not Answered363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care