Provider Demographics
NPI:1992554604
Name:MCLAUGHLAN, VICTORIA PAIGE (FNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:PAIGE
Last Name:MCLAUGHLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22700 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2016
Mailing Address - Country:US
Mailing Address - Phone:586-900-9555
Mailing Address - Fax:
Practice Address - Street 1:14270 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-1450
Practice Address - Country:US
Practice Address - Phone:586-900-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704356864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily