Healthcare Provider Details

I. General information

NPI: 1356448278
Provider Name (Legal Business Name): CARMEN LESLIE TRAILL PSY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N GILBERT RD STE # G-2
GILBERT AZ
85234-2328
US

IV. Provider business mailing address

PO BOX 22275
PHOENIX AZ
85028-0275
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-1542
  • Fax: 650-412-1542
Mailing address:
  • Phone: 602-402-1542
  • Fax: 650-412-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN051263
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: