Healthcare Provider Details

I. General information

NPI: 1023514981
Provider Name (Legal Business Name): VICTORIA KIM LERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST
PHILADELPHIA PA
19107-5002
US

IV. Provider business mailing address

2 OVERBROOK PKWY
WYNNEWOOD PA
19096-3518
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax: 215-923-6225
Mailing address:
  • Phone: 267-808-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP018341
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: