Provider Demographics
NPI:1558503813
Name:CARMEN TRAILL PLLC
Entity Type:Organization
Organization Name:CARMEN TRAILL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAILL
Authorized Official - Suffix:
Authorized Official - Credentials:PSY NP
Authorized Official - Phone:602-402-1542
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 1:1855 E SOUTHERN AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5241
Practice Address - Country:US
Practice Address - Phone:602-402-1542
Practice Address - Fax:650-412-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty