Basic Information
| Provider Information | |||||||||
| NPI: | 1861956500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAND | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | DENISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1018 N BRAGG BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283903316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552015498 | ||||||||
| FaxNumber: | 8888494249 | ||||||||
| Practice Location | |||||||||
| Address1: | 1018 N BRAGG BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102952609 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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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 | 106S00000X | RBT-18-72596 | NC | Y |
No ID Information.