Healthcare Provider Details

I. General information

NPI: 1104601533
Provider Name (Legal Business Name): MARY VICTORIA TRIMBLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY VICTORIA SPRINGER

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-8908
US

IV. Provider business mailing address

151 RUTLEDGE AVE BLDG B
CHARLESTON SC
29425-8903
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2381
  • Fax:
Mailing address:
  • Phone: 843-792-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.30412
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number256026
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: