Provider Demographics
NPI:1609566181
Name:THARP, VICTORIA C (NEMT -)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:THARP
Suffix:
Gender:F
Credentials:NEMT -
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 N 80TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4908
Mailing Address - Country:US
Mailing Address - Phone:414-322-6074
Mailing Address - Fax:
Practice Address - Street 1:2710 N 80TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-4908
Practice Address - Country:US
Practice Address - Phone:414-322-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WI172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI87-4783487OtherNONE EMERGENCY MEDICAL TRANSPORTATION PROVIDER