Healthcare Provider Details

I. General information

NPI: 1245088467
Provider Name (Legal Business Name): VICTORIA SOLAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 WEEKSVILLE RD BLDG 128
ELIZABETH CITY NC
27909-6701
US

IV. Provider business mailing address

175A MILLTOWN RD
SHILOH NC
27974-6221
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-6460
  • Fax:
Mailing address:
  • Phone: 252-455-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number298348
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: