1689682742 NPI number — DR. LINDA L TRELOAR PHD, APRN, BC, NP-C

Table of content: DR. LINDA L TRELOAR PHD, APRN, BC, NP-C (NPI 1689682742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689682742 NPI number — DR. LINDA L TRELOAR PHD, APRN, BC, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRELOAR
Provider First Name:
LINDA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, APRN, BC, NP-C
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:
1689682742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16423 E BAINBRIDGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN HILLS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85268-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-837-3301
Provider Business Mailing Address Fax Number:
480-837-3301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6344 E BROADWAY RD
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-854-9092
Provider Business Practice Location Address Fax Number:
480-854-2880
Provider Enumeration Date:
08/04/2006

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: 363LA2200X , with the licence number:  RN056251 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LG0600X , with the licence number: RN056251 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 104803 . This is a "GROUP PIN" identifier . This identifiers is of the category "OTHER".




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