Provider Demographics
NPI:1205570140
Name:WOTORSON, VICTORIA (CRNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WOTORSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:WORWELE
Other - Last Name:WEAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7034 INGRAHM DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8358
Mailing Address - Country:US
Mailing Address - Phone:240-486-1931
Mailing Address - Fax:
Practice Address - Street 1:5501 HOPKINS BAYVIEW CIR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6821
Practice Address - Country:US
Practice Address - Phone:410-550-5864
Practice Address - Fax:410-367-2711
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily