Healthcare Provider Details

I. General information

NPI: 1669200606
Provider Name (Legal Business Name): VICTORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 OXON HILL RD STE 200 #1103
FORT WASHINGTON MD
20744
US

IV. Provider business mailing address

8507 OXON HILL RD STE 200 #1103
FORT WASHINGTON MD
20744
US

V. Phone/Fax

Practice location:
  • Phone: 301-485-9643
  • Fax:
Mailing address:
  • Phone: 301-485-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIN PALMER
Title or Position: CEO
Credential: MSN, FNP, PMHNP-BC
Phone: 301-346-4141