Provider Demographics
NPI:1952425340
Name:PINK, VICTORIA R (RN, CCRC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:PINK
Suffix:
Gender:F
Credentials:RN, CCRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 28TH ST
Mailing Address - Street 2:SUITE 40
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1139
Mailing Address - Country:US
Mailing Address - Phone:612-863-6286
Mailing Address - Fax:612-863-6515
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 40
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-863-6286
Practice Address - Fax:612-863-6515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 068438-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse