Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP2370 | AZ |
NPI | 1093722969 |
---|---|
Provider Name | Mrs. Trina Llewellyn |
First Address | Phoenix, AZ 85032-4636 |
Second Address | Phoenix, AZ 85032-4636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ML1010761 | DEA (01) | AZ |
RN138371 | RN (01) | AZ |