Provider Demographics
NPI:1689682742
Name:TRELOAR, LINDA L (PHD, APRN, BC, NP-C)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:TRELOAR
Suffix:
Gender:F
Credentials:PHD, APRN, BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16423 E BAINBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2721
Mailing Address - Country:US
Mailing Address - Phone:480-837-3301
Mailing Address - Fax:480-837-3301
Practice Address - Street 1:6344 E BROADWAY RD
Practice Address - Street 2:SUITE 118
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1634
Practice Address - Country:US
Practice Address - Phone:480-854-9092
Practice Address - Fax:480-854-2880
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN056251363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
104803OtherGROUP PIN
AZS99313Medicare UPIN
106662Medicare ID - Type Unspecified