Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP61072776 | WA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP61072776 | WA |
NPI | 1033721667 |
---|---|
Provider Name | Kevin Michael Trippe |
First Address | Burien, WA 98166-3017 |
Second Address | Burien, WA 98166-3017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2020 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2165346 | (05) | WA |