Healthcare Provider Details

I. General information

NPI: 1518449768
Provider Name (Legal Business Name): VICTORIA O SODJE NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1298 RIVERWIND DR
LAWRENCEVILLE GA
30043-6414
US

IV. Provider business mailing address

1298 RIVERWIND DR
LAWRENCEVILLE GA
30043-6414
US

V. Phone/Fax

Practice location:
  • Phone: 973-432-1628
  • Fax:
Mailing address:
  • Phone: 973-432-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN228399
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN228399
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN228399
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: