Provider Demographics
NPI:1306286729
Name:VOLFSON, VICTORIA (RN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VOLFSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 S BLUE ISLAND AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2133
Mailing Address - Country:US
Mailing Address - Phone:312-772-6469
Mailing Address - Fax:773-888-3091
Practice Address - Street 1:1647 S BLUE ISLAND AVE
Practice Address - Street 2:2ND FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2133
Practice Address - Country:US
Practice Address - Phone:312-772-6469
Practice Address - Fax:773-888-3091
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041371679163W00000X, 163WC1600X, 163WH0200X, 163WW0000X, 163WX1500X, 164W00000X, 164X00000X, 372600000X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL462119710Medicaid
IL462119710Medicaid
IL46211970Medicare PIN