Provider Demographics
NPI:1255895256
Name:DUWYENIE, TRAVIS
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:DUWYENIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 S PAGE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325-5515
Mailing Address - Country:US
Mailing Address - Phone:928-301-2911
Mailing Address - Fax:
Practice Address - Street 1:665 S PAGE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CORNVILLE
Practice Address - State:AZ
Practice Address - Zip Code:86325-5515
Practice Address - Country:US
Practice Address - Phone:928-301-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program