Healthcare Provider Details

I. General information

NPI: 1356146518
Provider Name (Legal Business Name): KATHERINE LOUISE TRIBLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE LOUISE TRIBLEY RN

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 VILLAGE CREEK RD
APTOS CA
95003-3956
US

IV. Provider business mailing address

319 VILLAGE CREEK RD
APTOS CA
95003-3956
US

V. Phone/Fax

Practice location:
  • Phone: 509-630-9620
  • Fax:
Mailing address:
  • Phone: 509-630-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95033319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: