Healthcare Provider Details

I. General information

NPI: 1962645010
Provider Name (Legal Business Name): CARRIE ELIZABETH TRUBIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 COMMERCIAL ST STE 4
LIVONIA NY
14487-9112
US

IV. Provider business mailing address

20 LINDEN ST
LIVONIA NY
14487-9735
US

V. Phone/Fax

Practice location:
  • Phone: 585-733-6472
  • Fax:
Mailing address:
  • Phone: 585-733-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number22566905
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: