Provider Demographics
NPI:1518139997
Name:TRIBBLE, LARHONDA NICOLE (OWNER)
Entity Type:Individual
Prefix:MRS
First Name:LARHONDA
Middle Name:NICOLE
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 LAKESIDE VILLAGE DR
Mailing Address - Street 2:APT. 205
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6118
Mailing Address - Country:US
Mailing Address - Phone:586-876-2298
Mailing Address - Fax:586-421-4637
Practice Address - Street 1:15810 LAKESIDE VILLAGE DR
Practice Address - Street 2:APT. 205
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6118
Practice Address - Country:US
Practice Address - Phone:586-876-2298
Practice Address - Fax:586-421-4637
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIT614488630898172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver