Provider Demographics
NPI:1982585089
Name:CHANG, VICTORIAH SONG (NP)
Entity type:Individual
Prefix:
First Name:VICTORIAH
Middle Name:SONG
Last Name:CHANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17767 LAYTON PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5217
Mailing Address - Country:US
Mailing Address - Phone:651-895-3789
Mailing Address - Fax:
Practice Address - Street 1:17767 LAYTON PATH
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5217
Practice Address - Country:US
Practice Address - Phone:651-895-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily