Healthcare Provider Details

I. General information

NPI: 1689919946
Provider Name (Legal Business Name): RISCHELLE JOYCE TRAYNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 W MAPLEWOOD ST
CHANDLER AZ
85286-6831
US

IV. Provider business mailing address

1603 W MAPLEWOOD ST
CHANDLER AZ
85286-6831
US

V. Phone/Fax

Practice location:
  • Phone: 480-332-7975
  • Fax:
Mailing address:
  • Phone: 480-332-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN172542
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: