Provider Demographics
NPI:1982238960
Name:TREVAIL, ROSANNE GRACE (LPN)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:GRACE
Last Name:TREVAIL
Suffix:
Gender:F
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:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:CADYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12918-0153
Mailing Address - Country:US
Mailing Address - Phone:518-232-4361
Mailing Address - Fax:
Practice Address - Street 1:14 GENERAL R. PARKER AVE.
Practice Address - Street 2:
Practice Address - City:CADYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12918-0153
Practice Address - Country:US
Practice Address - Phone:518-232-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse