Provider Demographics
NPI:1396299616
Name:TRINH, DUY (NP)
Entity type:Individual
Prefix:
First Name:DUY
Middle Name:
Last Name:TRINH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-5040
Mailing Address - Country:US
Mailing Address - Phone:408-888-0524
Mailing Address - Fax:
Practice Address - Street 1:21525 SR 410 E STE A
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-4101
Practice Address - Country:US
Practice Address - Phone:253-499-6999
Practice Address - Fax:888-440-5188
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53864363LF0000X
MDR200614390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT-650-155-492-270OtherMARYLAND DRIVER LICENSE