Basic Information
| Provider Information | |||||||||
| NPI: | 1821189549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITCHFORD | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9894 EAST 121ST STREET | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460370000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176214800 | ||||||||
| FaxNumber: | 3176214700 | ||||||||
| Practice Location | |||||||||
| Address1: | 7229 CLEARVISTA DRIVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462561698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176214300 | ||||||||
| FaxNumber: | 3176214301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71001931A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200544800 | 05 | IN | MEDICAID | 000000589901 | 01 | IN | ANTHEM | OTHER | P01170029 | 01 | IN | RR MEDICARE PTAN | OTHER |