Provider Demographics
NPI:1093422420
Name:MCNAIR, VICKI D
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:D
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:D
Other - Last Name:TRUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:938 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2112
Mailing Address - Country:US
Mailing Address - Phone:567-315-2085
Mailing Address - Fax:
Practice Address - Street 1:938 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2112
Practice Address - Country:US
Practice Address - Phone:567-315-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347B00000X
OH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
No347B00000XTransportation ServicesBus