Provider Demographics
NPI:1023222148
Name:TRAPP, CAROLINE B (NP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:B
Last Name:TRAPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-355-0880
Mailing Address - Fax:248-355-9232
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 404
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-355-0880
Practice Address - Fax:248-355-9232
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704175528363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023222148Medicaid
MI500F318990OtherBLUE SHIELD
MI1023222148Medicaid
MI500F318990OtherBLUE SHIELD