Provider Demographics
NPI:1235897810
Name:HURTADO, TRINI MICHELLE-LAILIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TRINI
Middle Name:MICHELLE-LAILIE
Last Name:HURTADO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 E HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5938
Mailing Address - Country:US
Mailing Address - Phone:480-472-6175
Mailing Address - Fax:480-472-6150
Practice Address - Street 1:1445 E HILTON AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5938
Practice Address - Country:US
Practice Address - Phone:480-472-6175
Practice Address - Fax:480-472-6150
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250153163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool