Organization
VICTORY MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAPHNE RUSS GREEN NP (FNP/OWNER)
(910) 770-1514
Entity
Organization
Contact information
Practice address
305 SOUTH MAIN STREET, BLADENBORO, NC 28320
(910) 809-0082
Mailing address
305 SOUTH MAIN STREET, BLADENBORO, NC 28320
(910) 809-0082
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/27/2021
Last updated
08/11/2021
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