Provider Demographics
NPI:1124837729
Name:RUSH- WILSON, VICTORIA N (LPN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:N
Last Name:RUSH- WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:N
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:23 E ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6423
Mailing Address - Country:US
Mailing Address - Phone:918-216-4999
Mailing Address - Fax:
Practice Address - Street 1:23 E ROSS AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6423
Practice Address - Country:US
Practice Address - Phone:918-216-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0071417164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse