Healthcare Provider Details

I. General information

NPI: 1750625562
Provider Name (Legal Business Name): VICTORIA M VENTURELLA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR
HARVEY IL
60426-3558
US

IV. Provider business mailing address

11001 DEER CREEK DR
CROWN POINT IN
46307-7141
US

V. Phone/Fax

Practice location:
  • Phone: 708-333-2300
  • Fax:
Mailing address:
  • Phone: 312-848-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010202
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5005921
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010202
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004297A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: