Provider Demographics
NPI:1023065679
Name:TRUMBLE, LORETTA V (CRNP)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:V
Last Name:TRUMBLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11085 LITTLE PATUXENT PKWY
Mailing Address - Street 2:202
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY
Practice Address - Street 2:202
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2983
Practice Address - Country:US
Practice Address - Phone:410-715-1060
Practice Address - Fax:410-715-1063
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR122160363L00000X
MDTRU104262354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00688Medicare PIN
MDKQ48Medicare PIN