Healthcare Provider Details

I. General information

NPI: 1982009692
Provider Name (Legal Business Name): VICTORIA HANLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 3RD AVE SE
ABERDEEN SD
57401-5418
US

IV. Provider business mailing address

1601 OLIVE DR APT 2
ABERDEEN SD
57401-1132
US

V. Phone/Fax

Practice location:
  • Phone: 605-226-5500
  • Fax:
Mailing address:
  • Phone: 816-810-7357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1580
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: