Provider Demographics
NPI:1679379259
Name:CARLSON, VICTORIA (CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MONTCALM ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1398
Mailing Address - Country:US
Mailing Address - Phone:315-343-2590
Mailing Address - Fax:
Practice Address - Street 1:42 MONTCALM ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1398
Practice Address - Country:US
Practice Address - Phone:315-343-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002380363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology