Healthcare Provider Details

I. General information

NPI: 1245565431
Provider Name (Legal Business Name): VICTORIA ASHLEY GENT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA ASHLEY GRAY

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SOLEDAD LN
VANCEBORO NC
28586-7640
US

IV. Provider business mailing address

120 SOLEDAD LN
VANCEBORO NC
28586-7640
US

V. Phone/Fax

Practice location:
  • Phone: 252-675-0169
  • Fax:
Mailing address:
  • Phone: 252-675-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number221600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: