1023406048 NPI number — MRS. DEIRDRE TREANOR FNP-C

Table of content: MRS. DEIRDRE TREANOR FNP-C (NPI 1023406048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023406048 NPI number — MRS. DEIRDRE TREANOR FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREANOR
Provider First Name:
DEIRDRE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEHNER
Provider Other First Name:
DEIRDRE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023406048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARANA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85653-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-682-4111
Provider Business Mailing Address Fax Number:
520-682-3817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8181 E IRVINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85709-5876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-574-1551
Provider Business Practice Location Address Fax Number:
520-574-0783
Provider Enumeration Date:
12/29/2014

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: 363LF0000X , with the licence number:  AP7536 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 043194 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com