Provider Demographics
NPI:1689862021
Name:HUSTEY, VICTORIA R (CNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:HUSTEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:R
Other - Last Name:LAUDERDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29000 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5293
Mailing Address - Country:US
Mailing Address - Phone:440-835-8000
Mailing Address - Fax:
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5293
Practice Address - Country:US
Practice Address - Phone:440-835-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07276363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner