Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN076722 NP | GA |
NPI | 1013000249 |
---|---|
Provider Name | Shirley D Triche |
First Address | Fayetteville, GA 30214-3156 |
Second Address | Atlanta, GA 30322-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |