=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023514981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA KIM LERI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2018
-----------------------------------------------------
Last Update Date | 04/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 SANSOM ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-6844
-----------------------------------------------------
Fax | 215-923-6225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 OVERBROOK PKWY
-----------------------------------------------------
City | WYNNEWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19096-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-808-0275
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | SP018341
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------