Provider Demographics
NPI:1932985504
Name:HARRIOTT, VICTORIA LYN
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LYN
Last Name:HARRIOTT
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 1:6330 WHISPERING CREEK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5720
Mailing Address - Country:US
Mailing Address - Phone:702-769-1600
Mailing Address - Fax:
Practice Address - Street 1:6330 WHISPERING CREEK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5720
Practice Address - Country:US
Practice Address - Phone:702-769-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20243088338374J00000X
NVCHWI-5475172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1601714426Medicaid