Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 9267015 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN2337712 | MA |
NPI | 1003307596 |
---|---|
Provider Name | Marie C Victor |
First Address | Miramar, FL 33025-7404 |
Second Address | Holyoke, MA 01040-6616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2018 |
Last Update Date | 16/04/2020 |