Healthcare Provider Details

I. General information

NPI: 1942940390
Provider Name (Legal Business Name): VICTORIA WISBECK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA DRAKE RN

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

4301 X ST
SACRAMENTO CA
95817-2214
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61120669
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: