Healthcare Provider Details

I. General information

NPI: 1063486892
Provider Name (Legal Business Name): ANNA LAURA TRIMBUR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA LAURA METTEN

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY STE 312
LOUISVILLE KY
40207
US

IV. Provider business mailing address

4003 KRESGE WAY STE 312
LOUISVILLE KY
40207
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-7377
  • Fax: 502-899-1972
Mailing address:
  • Phone: 502-899-7377
  • Fax: 502-899-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2833P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2833P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: