Provider Demographics
NPI:1497258552
Name:TRIPP, LORENA R (RN)
Entity Type:Individual
Prefix:MS
First Name:LORENA
Middle Name:R
Last Name:TRIPP
Suffix:
Gender:F
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:PO BOX 797211
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-7211
Mailing Address - Country:US
Mailing Address - Phone:601-383-3526
Mailing Address - Fax:
Practice Address - Street 1:3605 NE LOOP 286 STE 200
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5091
Practice Address - Country:US
Practice Address - Phone:903-737-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX907604OtherREGISTERED NURSE