Provider Demographics
NPI:1275933269
Name:WARREN, VICTORIA ANN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13435 277TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-8672
Mailing Address - Country:US
Mailing Address - Phone:763-227-7338
Mailing Address - Fax:
Practice Address - Street 1:13435 277TH AVE NW
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-8672
Practice Address - Country:US
Practice Address - Phone:763-227-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency