Provider Demographics
NPI:1477660892
Name:TRAYNOR, JEANENE (CWNP)
Entity Type:Individual
Prefix:
First Name:JEANENE
Middle Name:
Last Name:TRAYNOR
Suffix:
Gender:F
Credentials:CWNP
Other - Prefix:
Other - First Name:JEANENE
Other - Middle Name:
Other - Last Name:TRAYNOR-WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CWNP
Mailing Address - Street 1:3660 W BETHANY HOME RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1953
Mailing Address - Country:US
Mailing Address - Phone:602-973-3200
Mailing Address - Fax:602-973-0508
Practice Address - Street 1:3660 W BETHANY HOME RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-1953
Practice Address - Country:US
Practice Address - Phone:602-973-3200
Practice Address - Fax:602-973-0508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN044212374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN044212OtherRN
AZMT0205410OtherDEA