Healthcare Provider Details

I. General information

NPI: 1902625544
Provider Name (Legal Business Name): VICTORIA DENISE AUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 VERMONT AVE
TOLEDO OH
43620-1443
US

IV. Provider business mailing address

2254 VERMONT AVE
TOLEDO OH
43620-1443
US

V. Phone/Fax

Practice location:
  • Phone: 419-975-7004
  • Fax:
Mailing address:
  • Phone: 419-975-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: