Provider Demographics
NPI:1538617246
Name:MUMMART, VIKTORIYA
Entity type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:
Last Name:MUMMART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIKTORIYA
Other - Middle Name:
Other - Last Name:SHETILOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:414 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHSPIRE
Mailing Address - State:PA
Mailing Address - Zip Code:17034-1407
Mailing Address - Country:US
Mailing Address - Phone:717-979-6698
Mailing Address - Fax:
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-761-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN671983163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology