Provider Demographics
NPI:1609974112
Name:VACCARO, VICTORIA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:VACCARO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:THEISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:730 KIMOLE LN
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1463
Mailing Address - Country:US
Mailing Address - Phone:517-263-6794
Mailing Address - Fax:517-263-4275
Practice Address - Street 1:730 KIMOLE LN
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1463
Practice Address - Country:US
Practice Address - Phone:517-263-6794
Practice Address - Fax:517-263-4275
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704150960163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5181698Medicaid
MI5181698Medicaid