Provider Demographics
NPI:1689241127
Name:PENA, VICKIANA
Entity type:Individual
Prefix:
First Name:VICKIANA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BEAVER ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4517
Mailing Address - Country:US
Mailing Address - Phone:917-396-9495
Mailing Address - Fax:
Practice Address - Street 1:27 BEAVER ST APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4517
Practice Address - Country:US
Practice Address - Phone:917-396-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2024-08-14
Deactivation Date:2022-07-08
Deactivation Code:
Reactivation Date:2024-08-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty