MEDICARE: KATHERINE LOUISE TRIBLEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	95033319	CA

General Provider Information

NPI Number	:	1356146518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LOUISE TRIBLEY RN

Provider Business Mailing Address
First Line	:	319 VILLAGE CREEK RD
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-3956
Country	:	US
Telephone Number	:	509-630-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 VILLAGE CREEK RD
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-3956
Country	:	US
Telephone Number	:	509-630-9620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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