Healthcare Provider Details

I. General information

NPI: 1609566181
Provider Name (Legal Business Name): VICTORIA C THARP NEMT -
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 N 80TH ST
MILWAUKEE WI
53222-4908
US

IV. Provider business mailing address

2710 N 80TH ST
MILWAUKEE WI
53222-4908
US

V. Phone/Fax

Practice location:
  • Phone: 414-322-6074
  • Fax:
Mailing address:
  • Phone: 414-322-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: