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:
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Health care specialties

SpecialtyCodeLicense #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 3 years ago

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790258473 NPPES
Illinois MEDICAID 209018588

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