Provider Demographics
NPI:1306885959
Name:TRIMBLE, NANCY A (RN CNP PHD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:RN CNP PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1890
Mailing Address - Country:US
Mailing Address - Phone:937-256-4490
Mailing Address - Fax:937-258-5478
Practice Address - Street 1:324 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1890
Practice Address - Country:US
Practice Address - Phone:937-256-4490
Practice Address - Fax:937-258-5478
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2568207Medicaid
OH2568207Medicaid
OHNP14922Medicare PIN