MEDICARE: JEANENE TRAYNOR CWNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374T00000X	Religious Nonmedical Nursing Personnel	RN044212	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN044212	OTHER	AZ	RN

General Provider Information

NPI Number	:	1477660892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANENE TRAYNOR CWNP

Provider Business Mailing Address
First Line	:	3660 W BETHANY HOME RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85019-1953
Country	:	US
Telephone Number	:	602-973-3200
Fax Number	:	602-973-0508

Provider Business Practice Location Address
First Line	:	3660 W BETHANY HOME RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85019-1953
Country	:	US
Telephone Number	:	602-973-3200
Fax Number	:	602-973-0508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	03/07/2023

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