Provider Demographics
NPI:1578672119
Name:BRIED, JEAN TRIMBLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:TRIMBLE
Last Name:BRIED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:TRIMBLE
Other - Last Name:BRIED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:7 DEYE LANE
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1269
Mailing Address - Country:US
Mailing Address - Phone:360-376-2561
Mailing Address - Fax:360-376-5183
Practice Address - Street 1:7 DEYE LN
Practice Address - Street 2:POB 1269
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8578
Practice Address - Country:US
Practice Address - Phone:360-376-2561
Practice Address - Fax:360-376-5183
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74202Medicare UPIN
8404162Medicare ID - Type Unspecified