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General NPI Number Information
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NPI Number | 1295246932
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Entity Type | Organization
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Legal Business Name | TRINITY HEALTH & WELLNESS FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 10/21/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 45 CAPRI BLVD STE F
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5657
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Country | US
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Telephone | 928-234-1177
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Fax | 928-733-6259
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Provider Business Mailing Address
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Address Line | 3869 CHESAPEAKE PL
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-4343
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Country | US
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Telephone | 603-731-5907
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | CHRIS ANN DIPAOLA
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Credential | FNP
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Telephone | 603-731-5907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP9834
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AP9834
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License Number State | AZ
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