Provider Demographics
NPI:1033733381
Name:TRIBON, SAMANTHA IRENE (LPN60760189)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:IRENE
Last Name:TRIBON
Suffix:
Gender:F
Credentials:LPN60760189
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19508 NE 399TH ST
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:WA
Mailing Address - Zip Code:98601-3234
Mailing Address - Country:US
Mailing Address - Phone:530-643-3263
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60760189164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse