Provider Demographics
NPI:1467134080
Name:TIPPERY, VICTORIA ANNETTE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNETTE
Last Name:TIPPERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 WESTMINSTER DR SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5849
Mailing Address - Country:US
Mailing Address - Phone:503-338-8953
Mailing Address - Fax:
Practice Address - Street 1:3785 WESTMINSTER DR SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5849
Practice Address - Country:US
Practice Address - Phone:503-338-8953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60452958163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient