Basic Information
| Provider Information | |||||||||
| NPI: | 1972516409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM K. TRIMBLE, CRNA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20621 N. 264TH AVE | ||||||||
| Address2: | |||||||||
| City: | BUCKEYE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282522504 | ||||||||
| FaxNumber: | 9282522504 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N WILLIAMSON AVE | ||||||||
| Address2: | |||||||||
| City: | WINSLOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860472735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282894691 | ||||||||
| FaxNumber: | 9282899180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TRIMBLE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | KENNETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CERTIFIED REGISTERED NURSE ANESTHET | ||||||||
| AuthorizedOfficialTelephone: | 6236065439 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN106462 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 493396 | 05 | AZ | MEDICAID |