1609100882 NPI number — CAROL A TETRICK RN

Table of content: CAROL A TETRICK RN (NPI 1609100882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609100882 NPI number — CAROL A TETRICK RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETRICK
Provider First Name:
CAROL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIPPS-TETRICK
Provider Other First Name:
CAROL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609100882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2238 E. GINTER ROAD
Provider Second Line Business Mailing Address:
SUNNYSIDE UNIFIED SCHOOL DISTRICT NO.12
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-545-2137
Provider Business Mailing Address Fax Number:
520-545-2120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2238 E. GINTER ROAD
Provider Second Line Business Practice Location Address:
SUNNYSIDE UNIFIED SCHOOL DISTRICT NO.12
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-545-2137
Provider Business Practice Location Address Fax Number:
520-545-2120
Provider Enumeration Date:
09/22/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WS0200X , with the licence number:  RN059193 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)