MEDICARE: ALLISON B TREVILLIAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0001196839	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06778	OTHER	VA	GROUP PTAN
2	C06695	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1275829673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON B TREVILLIAN NP

Provider Business Mailing Address
First Line	:	5207 HICKORY PARK DR
Second Line	:	SUITE A
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2624
Country	:	US
Telephone Number	:	804-612-2980
Fax Number	:	804-762-7102

Provider Business Practice Location Address
First Line	:	5207 HICKORY PARK DR
Second Line	:	SUITE A
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2624
Country	:	US
Telephone Number	:	804-612-2980
Fax Number	:	804-762-7102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	02/23/2012

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