Provider Demographics
NPI:1720369846
Name:TRIMBLE, LAURIS RENEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAURIS
Middle Name:RENEE
Last Name:TRIMBLE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-7081
Mailing Address - Country:US
Mailing Address - Phone:410-278-5475
Mailing Address - Fax:
Practice Address - Street 1:6455 MACHINE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5213
Practice Address - Country:US
Practice Address - Phone:410-278-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1098227363A00000X
VA0110008969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN