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NPI Code Detail

MEDICARE: MARY VICTORIA TRIMBLE CRNA

MEDICARE: MARY VICTORIA TRIMBLE CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPN.30412SC
2163WC0200XCritical Care Medicine Registered Nurse256026SC

General Provider Information

NPI Number : 1104601533
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY VICTORIA TRIMBLE CRNA
Provider Business Mailing Address
First Line : 151 RUTLEDGE AVE BLDG B
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-8903
Country : US
Telephone Number : 843-792-3328
Fax Number :
Provider Business Practice Location Address
First Line : 171 ASHLEY AVE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-8908
Country : US
Telephone Number : 843-792-2381
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2023
Last Update Date : 04/15/2026

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Directions to “ MARY VICTORIA TRIMBLE CRNA” Practice Location

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