Provider Demographics
NPI:1427671692
Name:SEVERSON, VICTORIA MARIE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:LEEPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1007 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROLFE
Mailing Address - State:IA
Mailing Address - Zip Code:50581-1066
Mailing Address - Country:US
Mailing Address - Phone:712-363-6336
Mailing Address - Fax:
Practice Address - Street 1:705 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROLFE
Practice Address - State:IA
Practice Address - Zip Code:50581-1029
Practice Address - Country:US
Practice Address - Phone:712-363-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider