Healthcare Provider Details

I. General information

NPI: 1134630643
Provider Name (Legal Business Name): VICTORIA HERRADURA LANDON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA HERRADURA CRNA

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY STE 270
SEATTLE WA
98122-5392
US

IV. Provider business mailing address

PO BOX 840842
DALLAS TX
75284-6954
US

V. Phone/Fax

Practice location:
  • Phone: 206-625-0578
  • Fax: 206-625-9184
Mailing address:
  • Phone: 206-625-0578
  • Fax: 206-625-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60293854
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60828828
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: