Healthcare Provider Details

I. General information

NPI: 1326495581
Provider Name (Legal Business Name): TRINA PRIMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDDAC JAPAN UNIT 45011
APO AP
96343-5011
US

IV. Provider business mailing address

MEDDAC JAPAN UNIT 45011
APO AP
96343-5011
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-4128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number28213451A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: