Provider Demographics
NPI:1902807803
Name:CROSS, VICTORIA (APNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1241
Mailing Address - Country:US
Mailing Address - Phone:920-361-2500
Mailing Address - Fax:920-361-2973
Practice Address - Street 1:191 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1241
Practice Address - Country:US
Practice Address - Phone:920-361-2500
Practice Address - Fax:920-361-2973
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86971-030163W00000X
WI424-033363L00000X
WI424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43986200Medicaid
WI007800416Medicare PIN
WIP10527Medicare UPIN