Provider Demographics
NPI:1194748517
Name:TRI, DEBRA (ARNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:TRI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SHELBY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-3599
Mailing Address - Country:US
Mailing Address - Phone:425-742-9119
Mailing Address - Fax:
Practice Address - Street 1:1025 153RD ST SE
Practice Address - Street 2:SUITE 200
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-4051
Practice Address - Country:US
Practice Address - Phone:425-745-4750
Practice Address - Fax:425-745-6158
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647934Medicaid