1669475612 NPI number — DEBBIE C TROTCHIE APN

Table of content: DEBBIE C TROTCHIE APN (NPI 1669475612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669475612 NPI number — DEBBIE C TROTCHIE APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROTCHIE
Provider First Name:
DEBBIE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUDDER
Provider Other First Name:
DEBBIE
Provider Other Middle Name:
C
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:
1669475612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6140 S FORT APACHE RD
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-6737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-933-6400
Provider Business Mailing Address Fax Number:
702-933-6412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6140 S FORT APACHE RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-933-6400
Provider Business Practice Location Address Fax Number:
702-933-6412
Provider Enumeration Date:
05/23/2005

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: 363LW0102X , with the licence number:  APN00355 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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