Amazing Victory LLC
Organization Active NPI Nurse Practitioner · Fairfield, CT
NPI 1134826712 · NPPES record last updated Feb 14, 2023
Key facts
- NPI
- 1134826712
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- AMAZING VICTORY LLC
- Practice address
- 1201 Kings Hwy Ste 2
Fairfield, CT 06824-5319 - Phone
- (475) 500-2334
- NPI assigned
- Feb 14, 2023
- Organization subpart
- No
Authorized official
- Name
- Mrs. Stephanie Larose, APRN
- Title
- Ceo
- Phone
- (475) 500-2334
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241002000185 | CT | Part B Supplier - Clinic/Group Practice | 0244761260 |
Receives reassigned benefits from 1 practitioner Practice locations: Bridgeport, CT |
National Provider Directory
Locations
1201 Kings Hwy
Ste 2
Fairfield, CT 06824
Phone (203) 521-1824
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
1201 Kings Hwy Ste 2
Fairfield, CT 06824-5319
Mailing address
1201 Kings Hwy Ste 2
Fairfield, CT 06824-5319
Phone (475) 500-2334
Other names
- Amazing Victory Health and Wellness LLC
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All providers in Fairfield, CT · Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.