Provider Demographics
NPI:1023896602
Name:TREVINO, CARLA ALEXANDRA (RN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ALEXANDRA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:ALEXANDRA
Other - Last Name:BENJERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 SCHOOLEY RD
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9109
Mailing Address - Country:US
Mailing Address - Phone:509-952-6701
Mailing Address - Fax:
Practice Address - Street 1:1211 AHTANUM RIDGE DR
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903
Practice Address - Country:US
Practice Address - Phone:509-966-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00165310163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse