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General NPI Number Information
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NPI Number | 1922234210
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Entity Type | Individual
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Provider Name | TRINETTE L RADASA ACNS, FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 2489 LARKSPUR DR
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City | ALPINE
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State | CA
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Zip | 91901-1334
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Country | US
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Telephone | 575-639-0139
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Fax | 619-324-4188
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Provider Business Mailing Address
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Address Line | 2489 LARKSPUR DR
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City | ALPINE
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State | CA
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Zip | 91901-1334
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Country | US
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Telephone | 575-639-0139
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-01898
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10023195
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | R44432
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95010084
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License Number State | CA
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