Provider Demographics
NPI:1023149408
Name:TRAHAN, VICTORIA K (RN, MED)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:K
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:RN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5420
Mailing Address - Country:US
Mailing Address - Phone:480-484-6209
Mailing Address - Fax:480-484-6228
Practice Address - Street 1:3811 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5420
Practice Address - Country:US
Practice Address - Phone:480-484-6209
Practice Address - Fax:480-484-6228
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN030303163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626640OtherAHCCCS