Healthcare Provider Details

I. General information

NPI: 1881852986
Provider Name (Legal Business Name): JUANITA ANN TRUJILLO APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N ORCHARD ST
MADISON WI
53715-1150
US

IV. Provider business mailing address

115 N ORCHARD ST
MADISON WI
53715-1150
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-8488
  • Fax:
Mailing address:
  • Phone: 608-265-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number831-033
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number841-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: