Provider Demographics
NPI:1174559157
Name:KOUTROUBA, DENISE MICHELE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MICHELE
Last Name:KOUTROUBA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:MICHELE
Other - Last Name:RANDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:JARRETT WHITE ROAD
Mailing Address - Street 2:TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-2460
Mailing Address - Fax:808-433-1558
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-2460
Practice Address - Fax:808-433-1558
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275890163WR1000X, 363LW0102X
MA264283363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/Infertility
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA275890OtherLICENSE
HI37OtherNURSE PRACTITIONER
MA264283OtherNURSE PRACTITIONER LICENS
HI37OtherNURSE PRACTITIONER