MEDICARE: SIERRA TRIPLETT 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	163W00000X	Registered Nurse	436280	OH

General Provider Information

NPI Number	:	1598288136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA TRIPLETT RN

Provider Business Mailing Address
First Line	:	PO BOX 351392
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43635-1392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 W BANCROFT ST #351392
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43635-1392
Country	:	US
Telephone Number	:	419-908-0828
Fax Number	:

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

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	11/03/2017

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