Provider Demographics
NPI:1881390144
Name:TROTTER, DEANNA L
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:TROTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 LAUREN LOOP
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-7865
Mailing Address - Country:US
Mailing Address - Phone:512-635-4920
Mailing Address - Fax:
Practice Address - Street 1:2416 LAUREN LOOP
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-7864
Practice Address - Country:US
Practice Address - Phone:512-635-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX804739952343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)