Healthcare Provider Details

I. General information

NPI: 1902934953
Provider Name (Legal Business Name): JOANNA CHRISTINE TRAUTMANN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST MAIL STOP P511D
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

7878 NIGHTINGALE WAY
SAN DIEGO CA
92123-2727
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8865
  • Fax: 619-692-8543
Mailing address:
  • Phone: 619-869-5564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberN665676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: