Individual
MS. VICTORIA DIANE VIVEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5159 S ASHLAND AVE, CHICAGO, IL 60609-4931
(773) 434-9216
Mailing address
5159 S ASHLAND AVE, CHICAGO, IL 60609-4931
(773) 434-9216
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007475
IL
Other
Enumeration date
12/20/2019
Last updated
01/17/2020
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