Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0101246301 | VA |
NPI | 1316190721 |
---|---|
Provider Name | Rickquel Tripp |
First Address | Chicago, IL 60637-1443 |
Second Address | Chicago, IL 60637-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2008 |
Last Update Date | 24/05/2021 |