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General NPI Number Information
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NPI Number | 1255942017
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Entity Type | Individual
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Provider Name | MARY VICTORIOUS CNM
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Gender | Female
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 143 NORTH ST STE 2
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City | AUBURN
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State | NY
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Zip | 13021-1852
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Country | US
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Telephone | 315-252-5028
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Fax | 315-252-1587
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Provider Business Mailing Address
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Address Line | 17 LANSING ST
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City | AUBURN
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State | NY
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Zip | 13021-1983
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Country | US
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Telephone | 315-255-7011
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Fax | 315-255-7099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 795713
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 002322
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License Number State | NY
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