Healthcare Provider Details

I. General information

NPI: 1104758804
Provider Name (Legal Business Name): VICTORIA CLAYBROOK BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 E WILSON ST
VALDERS WI
54245-9645
US

IV. Provider business mailing address

138 E WILSON ST
VALDERS WI
54245-9645
US

V. Phone/Fax

Practice location:
  • Phone: 920-775-9500
  • Fax: 920-775-9509
Mailing address:
  • Phone: 920-775-9500
  • Fax: 920-775-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number120458-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: