Provider Demographics
NPI:1083207732
Name:WILSON, VICTORIA (CD(DONA))
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CASSIUS CT
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2012
Mailing Address - Country:US
Mailing Address - Phone:859-582-7955
Mailing Address - Fax:
Practice Address - Street 1:406 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1998
Practice Address - Country:US
Practice Address - Phone:859-582-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty