Provider Demographics
NPI:1568845832
Name:SOLE PROPRIETOR
Entity Type:Organization
Organization Name:SOLE PROPRIETOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ALIN
Authorized Official - Last Name:TRAPUZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-222-2289
Mailing Address - Street 1:510 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3331
Mailing Address - Country:US
Mailing Address - Phone:724-222-2289
Mailing Address - Fax:
Practice Address - Street 1:510 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3331
Practice Address - Country:US
Practice Address - Phone:724-222-2289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015047261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care