1134001910 NPI number — VICTORIOUS PRESTIGE WELLNESS AND ADVOCACY SERVICES LLC

NPI Number: 1134001910
Health Care Provider/Practitioner: VICTORIOUS PRESTIGE WELLNESS AND ADVOCACY SERVICES LLC

NPI Number : 1134001910 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134001910",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VICTORIOUS PRESTIGE WELLNESS AND ADVOCACY SERVICES LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1707 BOCA LAGO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VALPARAISO",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46383-3905",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "219-617-4651",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1707 BOCA LAGO DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VALPARAISO",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46383-3905",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-617-4651",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/23/2025",
    "LastUpdateDate": "09/23/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SCHWARTEN",
    "AuthorizedOfficialFirstName": "VICTORIA",
    "AuthorizedOfficialMiddleName": "MARIE",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MSN, APRN, FNP-C",
    "AuthorizedOfficialTelephoneNumber": "219-617-4651",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WN1003X",
          "TaxonomyName": "Nutrition Support Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QD1600X",
          "TaxonomyName": "Developmental Disabilities Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "261QP2300X",
          "TaxonomyName": "Primary Care Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QU0200X",
          "TaxonomyName": "Urgent Care Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}