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General NPI Number Information
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NPI Number | 1427370428
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Entity Type | Individual
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Provider Name | THERESA MARIE TRIMMELL RN, CCM
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Gender | Female
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 19995 CLOVERLAND RD
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City | ASOTIN
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State | WA
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Zip | 99402-9708
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Country | US
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Telephone | 509-243-9996
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Fax | 509-243-9998
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Provider Business Mailing Address
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Address Line | PO BOX 77
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City | LEWISTON
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State | ID
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Zip | 83501-0077
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Country | US
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Telephone | 509-243-9996
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Fax | 509-243-9998
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | RN00111732
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License Number State | WA
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