Individual
MS. VICTORIA A HARGRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-2101
(618) 498-8153
Mailing address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-7518
(618) 498-3052
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041347129
IL
363LF0000X
Family Nurse Practitioner
277002358
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
277002358
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277002358
IL FPA APRN LICENSE
IL
Enumeration date
03/22/2009
Last updated
11/13/2024
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