Healthcare Provider Details

I. General information

NPI: 1376789107
Provider Name (Legal Business Name): CHEYANNA LYNN TRUJILLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 CARTHAGE ST
SANFORD NC
27330-6343
US

IV. Provider business mailing address

1007 CARTHAGE ST
SANFORD NC
27330-4114
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-1355
  • Fax: 919-775-1370
Mailing address:
  • Phone: 919-775-1355
  • Fax: 919-775-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: