Healthcare Provider Details

I. General information

NPI: 1861640930
Provider Name (Legal Business Name): VICTORIA LAND HUFF CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 TERRACE DR
DOWNERS GROVE IL
60516-3204
US

IV. Provider business mailing address

6911 TERRACE DR
DOWNERS GROVE IL
60516-3204
US

V. Phone/Fax

Practice location:
  • Phone: 360-241-5137
  • Fax: 360-241-5137
Mailing address:
  • Phone: 360-241-5137
  • Fax: 360-241-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201250031NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP3101
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: