Provider Demographics
NPI:1154925923
Name:CAUDILL, VICTORIA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 STATE ROUTE # 732
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320
Mailing Address - Country:US
Mailing Address - Phone:937-733-9693
Mailing Address - Fax:
Practice Address - Street 1:1488 STATE ROUTE # 732
Practice Address - Street 2:11183 STATE ROUTE 732
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311
Practice Address - Country:US
Practice Address - Phone:937-733-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide