Provider Demographics
NPI:1457038176
Name:AGUIRRE, TRICIA LEILANI (LPN)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:LEILANI
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LEILANI
Other - Last Name:MENDIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7070 NE 54TH ST APT 29
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3613
Mailing Address - Country:US
Mailing Address - Phone:360-623-6528
Mailing Address - Fax:
Practice Address - Street 1:5197 NW LOWER RIVER RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1013
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61156949164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse