Trivede, Punam Subhashchandra
Trivede, Punam Subhashchandra is an individual health care provider with primary practice located at 711 W John Gwynn Ave , Peoria IL 61605-2270. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Trivede, Punam Subhashchandra can be contacted via phone (309) 680-7600.Contact Information
Primary practice address
711 W John Gwynn Ave
Peoria IL 61605-2270
Phone: (309) 680-7600
Fax: (309) 671-2188
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | 209018588 | Illinois |
Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 209018588 | Illinois |
Profile Details
NPI number | 1790258473 |
---|---|
LBN Legal business name | Trivede, Punam Subhashchandra |
Credentials | Advanced Practice Nurse (APN) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jan 6th, 2019 |
Last updated | Jul 6th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1790258473 | NPPES |
Illinois | MEDICAID | 209018588 |
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