Healthcare Provider Details

I. General information

NPI: 1518525880
Provider Name (Legal Business Name): VIOLA MARITIM APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 1ST DR NW
AUSTIN MN
55912-2941
US

IV. Provider business mailing address

1000 1ST DR NW
AUSTIN MN
55912-2941
US

V. Phone/Fax

Practice location:
  • Phone: 507-377-6285
  • Fax:
Mailing address:
  • Phone: 507-377-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP020405
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number20148001523
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9272
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: