Provider Demographics
NPI:1629765227
Name:TRANQUILLO, VIENNA (CHN)
Entity Type:Individual
Prefix:
First Name:VIENNA
Middle Name:
Last Name:TRANQUILLO
Suffix:
Gender:F
Credentials:CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1771
Mailing Address - Country:US
Mailing Address - Phone:475-882-0888
Mailing Address - Fax:
Practice Address - Street 1:3 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1771
Practice Address - Country:US
Practice Address - Phone:475-882-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist