Healthcare Provider Details

I. General information

NPI: 1801303185
Provider Name (Legal Business Name): VICTORIA A NELSON-LARYEA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N DUPONT HWY # 1682
DOVER DE
19901-2006
US

IV. Provider business mailing address

1041 N DUPONT HWY # 1682
DOVER DE
19901-2006
US

V. Phone/Fax

Practice location:
  • Phone: 404-277-0001
  • Fax:
Mailing address:
  • Phone: 404-277-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0011017
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberL1-0076569
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: