Healthcare Provider Details

I. General information

NPI: 1205915311
Provider Name (Legal Business Name): MARY ELIZABETH TRABALKA ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 19TH ST. SUITE 401
KNOXVILLE TN
37916-1839
US

IV. Provider business mailing address

501 19TH ST. SUITE 401
KNOXVILLE TN
37916-1839
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-1975
  • Fax: 865-541-1976
Mailing address:
  • Phone: 865-541-1975
  • Fax: 865-541-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN0000084330
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: