Provider Demographics
NPI:1861120339
Name:TRICKETT, SALLY DANIELLE (CRNA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:DANIELLE
Last Name:TRICKETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 2259
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0023
Mailing Address - Country:US
Mailing Address - Phone:478-952-6317
Mailing Address - Fax:
Practice Address - Street 1:DR HITZELBERGER STRASSE
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:AE
Practice Address - Zip Code:66849
Practice Address - Country:US
Practice Address - Phone:314-590-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236323367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered