Provider Demographics
NPI:1427370428
Name:TRIMMELL, THERESA MARIE (RN, CCM)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:TRIMMELL
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0077
Mailing Address - Country:US
Mailing Address - Phone:509-243-9996
Mailing Address - Fax:509-243-9998
Practice Address - Street 1:19995 CLOVERLAND RD
Practice Address - Street 2:
Practice Address - City:ASOTIN
Practice Address - State:WA
Practice Address - Zip Code:99402-9708
Practice Address - Country:US
Practice Address - Phone:509-243-9996
Practice Address - Fax:509-243-9998
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00111732163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management