Provider Demographics
NPI:1588864912
Name:PLESHKAN, VIKTORIYA Y (NP)
Entity type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:Y
Last Name:PLESHKAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4028
Mailing Address - Country:US
Mailing Address - Phone:317-383-6035
Mailing Address - Fax:
Practice Address - Street 1:7230 ENGLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2209
Practice Address - Country:US
Practice Address - Phone:260-459-7313
Practice Address - Fax:260-436-0628
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000210455163W00000X
TN0000020443363LF0000X
IN71002424A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN669740NMedicare PIN