Healthcare Provider Details

I. General information

NPI: 1841600830
Provider Name (Legal Business Name): TRIMANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 E JOYCE BLVD
FAYETTEVILLE AR
72703-4524
US

IV. Provider business mailing address

2875 E JOYCE BLVD
FAYETTEVILLE AR
72703-4524
US

V. Phone/Fax

Practice location:
  • Phone: 479-966-4999
  • Fax: 479-966-4987
Mailing address:
  • Phone: 479-966-4999
  • Fax: 479-966-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SHIRRANNA M TODD
Title or Position: OWNER/OPERATOR
Credential: BA
Phone: 479-301-8829