Provider Demographics
NPI:1386874162
Name:GANZ, VICTORIA (ACNP-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GANZ
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BACK RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT POINT
Mailing Address - State:ME
Mailing Address - Zip Code:04667-4119
Mailing Address - Country:US
Mailing Address - Phone:207-853-0644
Mailing Address - Fax:
Practice Address - Street 1:11 BACK RD
Practice Address - Street 2:
Practice Address - City:PLEASANT POINT
Practice Address - State:ME
Practice Address - Zip Code:04667-4119
Practice Address - Country:US
Practice Address - Phone:207-853-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121007364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care