Provider Demographics
NPI:1285820381
Name:TRIVETT, AMBER (BCABA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:TRIVETT
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 SHINING STAR LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9890
Mailing Address - Country:US
Mailing Address - Phone:317-372-5303
Mailing Address - Fax:
Practice Address - Street 1:613 SHINING STAR LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9890
Practice Address - Country:US
Practice Address - Phone:317-372-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor