Provider Demographics
NPI:1336125517
Name:VANROY, VICTORIA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VANROY
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 1:18881 MAYBERRY PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5621
Mailing Address - Country:US
Mailing Address - Phone:952-237-3430
Mailing Address - Fax:402-933-7767
Practice Address - Street 1:16910 FRANCES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2398
Practice Address - Country:US
Practice Address - Phone:402-505-8777
Practice Address - Fax:402-933-7767
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35567207N00000X
MN36205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology