Provider Demographics
NPI:1679631733
Name:TRIVINO, LEIGH ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANNE
Last Name:TRIVINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANNE
Other - Last Name:ELSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:611 N IRON BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4932
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:
Practice Address - Street 1:5901 N LIDGERWOOD ST STE 126
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1122
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00100-00387363A00000X
NMPA-2013-0041363AM0700X
WAPA60201698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical