Provider Demographics
NPI:1821144775
Name:TRIPP, GENA M
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:M
Last Name:TRIPP
Suffix:
Gender:F
Credentials:
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 81
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:ME
Mailing Address - Zip Code:04965-0081
Mailing Address - Country:US
Mailing Address - Phone:207-938-2367
Mailing Address - Fax:
Practice Address - Street 1:19 MARIAN DRIVE
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:ME
Practice Address - Zip Code:04965
Practice Address - Country:US
Practice Address - Phone:207-938-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME215190000Medicare UPIN