Healthcare Provider Details

I. General information

NPI: 1154079556
Provider Name (Legal Business Name): VICTORIA LABONTE DECKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 INDUSTRIAL PARK RD
CONWAY SC
29526-5482
US

IV. Provider business mailing address

1931 INDUSTRIAL PARK RD
CONWAY SC
29526-5482
US

V. Phone/Fax

Practice location:
  • Phone: 843-254-0375
  • Fax:
Mailing address:
  • Phone: 843-254-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32808
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number248820
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: