Provider Demographics
NPI: | 1174232953 |
---|---|
Name: | RAHMANOVA, VIKTORIA (RN, CWOCN) |
Entity type: | Individual |
Prefix: | MRS |
First Name: | VIKTORIA |
Middle Name: | |
Last Name: | RAHMANOVA |
Suffix: | |
Gender: | F |
Credentials: | RN, CWOCN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 33 JOVAL CT |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11229-5966 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-288-4031 |
Mailing Address - Fax: | 775-258-7029 |
Practice Address - Street 1: | 33 JOVAL CT |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11229-5966 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-288-4031 |
Practice Address - Fax: | 775-258-7029 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2022-11-21 |
Last Update Date: | 2022-11-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 612476 | 163WC2100X, 163WX1500X, 163WW0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care |
No | 163WC2100X | Nursing Service Providers | Registered Nurse | Continence Care |
No | 163WX1500X | Nursing Service Providers | Registered Nurse | Ostomy Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
000000 | Other | N/A |