Healthcare Provider Details

I. General information

NPI: 1174559157
Provider Name (Legal Business Name): DENISE MICHELE KOUTROUBA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE MICHELE RANDLE NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

JARRETT WHITE ROAD TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2460
  • Fax: 808-433-1558
Mailing address:
  • Phone: 808-433-2460
  • Fax: 808-433-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License Number275890
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number275890
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number264283
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: