Provider Demographics
NPI:1205039864
Name:TRUMBULL, KAY TERESE
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:TERESE
Last Name:TRUMBULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4703
Mailing Address - Country:US
Mailing Address - Phone:520-795-4646
Mailing Address - Fax:
Practice Address - Street 1:4025 E 17TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-4703
Practice Address - Country:US
Practice Address - Phone:520-795-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant