Healthcare Provider Details

I. General information

NPI: 1831354828
Provider Name (Legal Business Name): VICTORIA ANN BLUCHER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2008
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 PULASKI HWY STE 203
HAVRE DE GRACE MD
21078-2147
US

IV. Provider business mailing address

414 SPRY ISLAND RD
JOPPA MD
21085-5436
US

V. Phone/Fax

Practice location:
  • Phone: 443-843-6262
  • Fax: 443-843-6264
Mailing address:
  • Phone: 443-559-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR144844
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: