MEDICARE: MS. DANNEILLE C TRUJILLO-HANSEN APRNBC

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	041223102	IL
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	209004760	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CF3444	OTHER	IL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	04122312	OTHER	IL	LICENSE NUMBER

General Provider Information

NPI Number	:	1538150107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANNEILLE C TRUJILLO-HANSEN APRNBC

Provider Business Mailing Address
First Line	:	109 CALIFORNIA ST
Second Line	:
City	:	CARTERVILLE
State	:	IL
Zip	:	62918-1923
Country	:	US
Telephone Number	:	618-985-8221
Fax Number	:	618-985-6860

Provider Business Practice Location Address
First Line	:	1506 SIOUX DR
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-5209
Country	:	US
Telephone Number	:	618-997-5270
Fax Number	:	618-997-5029

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	09/13/2012

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Directions to “ MS. DANNEILLE C TRUJILLO-HANSEN APRNBC” Practice Location

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