Provider Demographics
NPI:1952523029
Name:TRABUCCHI, VICTORIA F (MS RN CPNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:F
Last Name:TRABUCCHI
Suffix:
Gender:F
Credentials:MS RN CPNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:TRABUCCHI
Other - Last Name:ADDISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2243 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5602
Mailing Address - Country:US
Mailing Address - Phone:248-689-0201
Mailing Address - Fax:
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:SUITE 365
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119503363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics