Provider Demographics
NPI:1356448278
Name:TRAILL, CARMEN LESLIE (PSY NP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LESLIE
Last Name:TRAILL
Suffix:
Gender:F
Credentials:PSY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22275
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-0275
Mailing Address - Country:US
Mailing Address - Phone:602-402-1542
Mailing Address - Fax:650-412-1542
Practice Address - Street 1:1400 N GILBERT RD
Practice Address - Street 2:STE # G-2
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2328
Practice Address - Country:US
Practice Address - Phone:602-402-1542
Practice Address - Fax:650-412-1542
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN051263163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75214Medicare ID - Type Unspecified
Z127076Medicare PIN