1700159431 NPI number — MARVINA TRUSS LCPC

Table of content: MARVINA TRUSS LCPC (NPI 1700159431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700159431 NPI number — MARVINA TRUSS LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUSS
Provider First Name:
MARVINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700159431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RURAL CLINICS PAHRUMP
Provider Second Line Business Mailing Address:
240 S.HUMAHUASCA
Provider Business Mailing Address City Name:
PAHRUMP
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-751-7406
Provider Business Mailing Address Fax Number:
775-751-7409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RURAL CLINICS PAHRUMP
Provider Second Line Business Practice Location Address:
240 S.HUMAHUASCA
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-751-7406
Provider Business Practice Location Address Fax Number:
775-751-7409
Provider Enumeration Date:
02/10/2012

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: 101YM0800X , with the licence number:  0004226958 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CP1260 , 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)

  • Identifier: 0004226958 . This is a "STATE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".