Provider Demographics
NPI:1861622565
Name:NALLS, VICTORIA ANN (GNP-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:NALLS
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 MARSHALEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075
Mailing Address - Country:US
Mailing Address - Phone:703-915-5557
Mailing Address - Fax:410-379-3590
Practice Address - Street 1:6095 MARSHALEE DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6053
Practice Address - Country:US
Practice Address - Phone:703-915-5557
Practice Address - Fax:410-379-3590
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169140363LG0600X
MDAC000941363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology