Provider Demographics
NPI:1992163679
Name:STANSBERRY, TRENA MELEE (RN)
Entity type:Individual
Prefix:
First Name:TRENA
Middle Name:MELEE
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8318 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-8116
Mailing Address - Country:US
Mailing Address - Phone:623-512-5862
Mailing Address - Fax:623-691-5021
Practice Address - Street 1:8318 W SURREY AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-8116
Practice Address - Country:US
Practice Address - Phone:623-512-5862
Practice Address - Fax:623-691-5021
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN106999163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse