MEDICARE: VICTORIA TRIPP RN

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
1	163W00000X	Registered Nurse	4704356428	MI
2	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.0020668	OH

General Provider Information

NPI Number	:	1285206268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA TRIPP RN

Provider Business Mailing Address
First Line	:	7095 EPPING DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7095 EPPING DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2724
Country	:	US
Telephone Number	:	734-474-6031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2021
Last Update Date	:	11/16/2022

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