Provider Demographics
NPI:1275533671
Name:TRIBOUT, DALE L (RN, COHN-S)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:L
Last Name:TRIBOUT
Suffix:
Gender:M
Credentials:RN, COHN-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:STE 1D03
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5604
Mailing Address - Country:US
Mailing Address - Phone:912-435-5101
Mailing Address - Fax:912-435-5009
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:STE 1D03
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5604
Practice Address - Country:US
Practice Address - Phone:912-435-5101
Practice Address - Fax:912-435-5009
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN094051163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health