Provider Demographics
NPI:1629616941
Name:KOUANANG, VICTORIA ANNE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:KOUANANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MORRIS AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1224
Mailing Address - Country:US
Mailing Address - Phone:303-330-7391
Mailing Address - Fax:
Practice Address - Street 1:155 MORRIS AVE STE 204
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1224
Practice Address - Country:US
Practice Address - Phone:973-232-2300
Practice Address - Fax:973-232-2301
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN705911363LA2100X
NJ26NJ01203100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care