Healthcare Provider Details

I. General information

NPI: 1861014664
Provider Name (Legal Business Name): ANNIE CAMACHO TRUSSO DNAP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMONWEALTH HEALTH CENTER 500409
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 502415
SAIPAN MP
96950-2415
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1033578
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNP20010
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: