Provider Demographics
NPI:1245569789
Name:TRIMBLE, STEPHEN ROSS (RN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROSS
Last Name:TRIMBLE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOND ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4040
Mailing Address - Country:US
Mailing Address - Phone:920-437-1914
Mailing Address - Fax:
Practice Address - Street 1:1115 BOND ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4040
Practice Address - Country:US
Practice Address - Phone:920-437-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152787-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse