Healthcare Provider Details

I. General information

NPI: 1023607686
Provider Name (Legal Business Name): VICTORIA DUBE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 ALTAMONT PLACE
WHITE PLAINS MD
20695-3022
US

IV. Provider business mailing address

24035 THREE NOTCH RD
HOLLYWOOD MD
20636-4871
US

V. Phone/Fax

Practice location:
  • Phone: 240-518-6020
  • Fax: 240-518-6021
Mailing address:
  • Phone: 301-373-7900
  • Fax: 301-373-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR195933
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: