Healthcare Provider Details

I. General information

NPI: 1245744705
Provider Name (Legal Business Name): BRIANNA TRIPLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 RUSH BLVD
YOUNGSTOWN OH
44507-1535
US

IV. Provider business mailing address

PO BOX 6832
YOUNGSTOWN OH
44501-6832
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-1181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number426997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: