Healthcare Provider Details

I. General information

NPI: 1225275811
Provider Name (Legal Business Name): VICTORIA ANN MERREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA ANN BENNER

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N LINCOLN AVE BOX 233
LAKEVIEW MI
48850-9006
US

IV. Provider business mailing address

1021 E MAIN ST
EDMORE MI
48829-8740
US

V. Phone/Fax

Practice location:
  • Phone: 989-352-7800
  • Fax: 989-352-8080
Mailing address:
  • Phone: 989-427-5320
  • Fax: 989-427-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704145412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: