Provider Demographics
NPI:1568245488
Name:TRIVINO, MARGARET M (PMHNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:TRIVINO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SPRUCE ST STE C&D
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3455
Mailing Address - Country:US
Mailing Address - Phone:505-747-0081
Mailing Address - Fax:
Practice Address - Street 1:835 SPRUCE ST STE C&D
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3455
Practice Address - Country:US
Practice Address - Phone:505-747-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75123363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health