Provider Demographics
NPI:1386971323
Name:TRIVIC, AIDA (NP)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:TRIVIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BOONES LICK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2463
Mailing Address - Country:US
Mailing Address - Phone:636-916-8228
Mailing Address - Fax:636-946-5774
Practice Address - Street 1:802 MEL CARNAHAN DR
Practice Address - Street 2:APT 2015
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-2427
Practice Address - Country:US
Practice Address - Phone:636-543-2290
Practice Address - Fax:636-789-2523
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018080363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health