Provider Demographics
NPI:1649098849
Name:TRIPP, EMILEE MARIE
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:MARIE
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 1:865 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1021
Mailing Address - Country:US
Mailing Address - Phone:570-406-1945
Mailing Address - Fax:
Practice Address - Street 1:865 WILLARD ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1021
Practice Address - Country:US
Practice Address - Phone:570-406-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant