Healthcare Provider Details

I. General information

NPI: 1205393261
Provider Name (Legal Business Name): VICTORIA SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 LARKWOOD DR
OKLAHOMA CITY OK
73115-2824
US

IV. Provider business mailing address

P.O BOX 30292
OKLAHOMA CITY OK
73140
US

V. Phone/Fax

Practice location:
  • Phone: 405-476-5766
  • Fax:
Mailing address:
  • Phone: 405-476-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0089292
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: