Provider Demographics
NPI:1215212717
Name:TRUDEL, (DEBORAH) 'ANNE' (NP)
Entity Type:Individual
Prefix:
First Name:(DEBORAH) 'ANNE'
Middle Name:
Last Name:TRUDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 ALTA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2800
Mailing Address - Country:US
Mailing Address - Phone:909-985-1908
Mailing Address - Fax:909-985-6828
Practice Address - Street 1:1113 ALTA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2800
Practice Address - Country:US
Practice Address - Phone:909-985-1908
Practice Address - Fax:909-985-6828
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily