Healthcare Provider Details

I. General information

NPI: 1043471774
Provider Name (Legal Business Name): NANCY J TRAMMELL CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBUR RD
THIELLS NY
10984-7555
US

IV. Provider business mailing address

2 BENNETT ST
PORT JERVIS NY
12771-2303
US

V. Phone/Fax

Practice location:
  • Phone: 845-947-6220
  • Fax:
Mailing address:
  • Phone: 845-858-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number004499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: