Individual
JUDITH L TREVISANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
2500 CANYON RD STE A1, BULLHEAD CITY, AZ 86442-8492
(928) 704-4499
(928) 704-7494
Mailing address
2500 CANYON RD STE A1, BULLHEAD CITY, AZ 86442-8492
(928) 704-4499
(928) 704-4949
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
TEMP305268
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760842512
—
NV
Enumeration date
03/07/2016
Last updated
04/23/2024
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