Provider Demographics
NPI:1225275811
Name:MERREN, VICTORIA ANN (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:MERREN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:BENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48829-8740
Mailing Address - Country:US
Mailing Address - Phone:989-427-5320
Mailing Address - Fax:989-427-8220
Practice Address - Street 1:323 N LINCOLN AVE
Practice Address - Street 2:BOX 233
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9006
Practice Address - Country:US
Practice Address - Phone:989-352-7800
Practice Address - Fax:989-352-8080
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704145412OtherMICHIGAN STATE
MI5008709230OtherBCBSM
MI5008709230OtherBCBSM