1669475612 NPI number — DEBBIE C TROTCHIE APN

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal 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 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	:	1669475612
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	11/12/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	PO BOX 1737
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	LAS VEGAS
Provider Business Mailing Address State Name	:	NV
Provider Business Mailing Address Postal Code	:	891251737
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	7026716845
Provider Business Mailing Address Fax Number	:	7026716883

Provider First Line Business Practice Location Address	:	3196 S MARYLAND PKWY
Provider Second Line Business Practice Location Address	:	STE 303
Provider Business Practice Location Address City Name	:	LAS VEGAS
Provider Business Practice Location Address State Name	:	NV
Provider Business Practice Location Address Postal Code	:	891092305
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	7023832919
Provider Business Practice Location Address Fax Number	:	7023832886
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
Authorized Official Middle Name	:
Authorized Official Title or Position	:
Authorized Official Telephone Number	:

• Taxonomy code: 363LW0102X , with the licence number:  APN00355 , registered in the state of NV .