Healthcare Provider Details

I. General information

NPI: 1417684853
Provider Name (Legal Business Name): VICTORIA SKORCZEWSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W MAIN ST STE 200
MARSHALL MN
56258-3171
US

IV. Provider business mailing address

1805 340TH ST
IVANHOE MN
56142-4055
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-1214
  • Fax:
Mailing address:
  • Phone: 507-828-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2494229
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number2494229
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: