Provider Demographics
NPI:1225365273
Name:TRINITY PROFESSIONAL HEALTHCARE SERVICES,LLC
Entity Type:Organization
Organization Name:TRINITY PROFESSIONAL HEALTHCARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:GAITOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:504-628-7229
Mailing Address - Street 1:2913 AMAZON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6501
Mailing Address - Country:US
Mailing Address - Phone:504-628-7229
Mailing Address - Fax:504-366-7229
Practice Address - Street 1:2913 AMAZON ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6501
Practice Address - Country:US
Practice Address - Phone:504-628-7229
Practice Address - Fax:504-366-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO1097251E00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1537853Medicaid
LA1537853Medicaid