Healthcare Provider Details

I. General information

NPI: 1548564750
Provider Name (Legal Business Name): LITTLE CHEYANNA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 CARTHAGE STREET
SANFORD NC
27330
US

IV. Provider business mailing address

1007 CARTHAGE STREET
SANFORD NC
27330
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-1355
  • Fax: 919-775-1370
Mailing address:
  • Phone: 919-775-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number107601
License Number StateNC

VIII. Authorized Official

Name: CHEYANNA LYNN TRUJILLO
Title or Position: OWNER
Credential: FNP-C
Phone: 919-775-1310