MEDICARE: NICOLLE BETH TRUDEAU

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1588815179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLLE BETH TRUDEAU

Provider Business Mailing Address
First Line	:	2044 E 32ND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-3832
Country	:	US
Telephone Number	:	520-668-1623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2044 E 32ND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-3832
Country	:	US
Telephone Number	:	520-668-1623
Fax Number	:

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

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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Directions to “ NICOLLE BETH TRUDEAU ” Practice Location

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