Basic Information
| Provider Information | |||||||||
| NPI: | 1609284355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERJOK | ||||||||
| FirstName: | TRELANE | ||||||||
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| Credential: | APRN / ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 65 | ||||||||
| Address2: | |||||||||
| City: | RICHVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628770065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757222834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 GOOD SAMARITAN WAY | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182424600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2014 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60489776 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 209020155 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.