1548349368 NPI number — MS. SANDRA SUZANNE TRUJILLO ARNP

Table of content: MS. SANDRA SUZANNE TRUJILLO ARNP (NPI 1548349368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548349368 NPI number — MS. SANDRA SUZANNE TRUJILLO ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUJILLO
Provider First Name:
SANDRA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUSAM
Provider Other First Name:
SANDRA
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548349368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 S UTICA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74104-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-582-9355
Provider Business Mailing Address Fax Number:
918-594-4889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 S UTICA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-582-9355
Provider Business Practice Location Address Fax Number:
918-594-4889
Provider Enumeration Date:
11/03/2006

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: 363L00000X , with the licence number:  R0054977 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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