1538150107 NPI number — MS. DANNEILLE C TRUJILLO-HANSEN APRNBC

Table of content: MS. DANNEILLE C TRUJILLO-HANSEN APRNBC (NPI 1538150107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538150107 NPI number — MS. DANNEILLE C TRUJILLO-HANSEN APRNBC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUJILLO-HANSEN
Provider First Name:
DANNEILLE
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRNBC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSEN
Provider Other First Name:
DANNEILLE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRNBC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538150107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 CALIFORNIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62918-1923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-985-8221
Provider Business Mailing Address Fax Number:
618-985-6860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1506 SIOUX DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62959-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-997-5270
Provider Business Practice Location Address Fax Number:
618-997-5029
Provider Enumeration Date:
11/02/2005

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: 364SP0809X , with the licence number:  041223102 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: 209004760 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 370966854011 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370966854023 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF3444 . This is a "MEDICARE RR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 04122312 . This is a "LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com