NPI 1134826712 · live from the CMS NPI Registry
Amazing Victory LLC
Nurse Practitioner in Fairfield, CT. National Provider Identifier 1134826712, active.
NPI record
| NPI | 1134826712 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner 363L00000X |
| Practice location | 1201 Kings Hwy Ste 2, Fairfield, CT 06824 |
| Practice phone | 475-500-2334 |
| Enumerated | February 14, 2023 |
| Last updated | February 14, 2023 |
| Authorized official | Stephanie Larose, Ceo |
| Other names | Amazing Victory Health And Wellness LLC |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner primary | 363L00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.