Provider Demographics
NPI:1104325216
Name:UNDERWOOD, VICTORIA RACHEL (ARNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:RACHEL
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:RACHEL
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:305 W 15TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2455
Mailing Address - Country:US
Mailing Address - Phone:620-624-9637
Mailing Address - Fax:620-624-2218
Practice Address - Street 1:305 W 15TH ST STE 104
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-9637
Practice Address - Fax:620-624-2218
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5377897022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily