MEDICARE: SHANNA MARIE TRELFORD RN PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	570937	TX

General Provider Information

NPI Number	:	1568525434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNA MARIE TRELFORD RN PMHNP

Provider Business Mailing Address
First Line	:	2600 N STEMMONS FWY STE 151
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-2111
Country	:	US
Telephone Number	:	888-905-0595
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 N STEMMONS FWY
Second Line	:	SUITE 151
City	:	DALLAS
State	:	TX
Zip	:	75207-2113
Country	:	US
Telephone Number	:	888-905-0595
Fax Number	:	214-459-2530

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/04/2013

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