Provider Demographics
NPI:1780156109
Name:FAIRCHILD, TROY DOUGLAS (LPN)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:DOUGLAS
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 E CHIA RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4719
Mailing Address - Country:US
Mailing Address - Phone:562-500-6131
Mailing Address - Fax:
Practice Address - Street 1:990 E CHIA RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4719
Practice Address - Country:US
Practice Address - Phone:562-500-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701719164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse