PUNAM SUBHASHCHANDRA TRIVEDE APN NPI 1790258473

NPI Information

  • NPI: 1790258473
  • Provider Name: PUNAM SUBHASHCHANDRA TRIVEDE, APN
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 711 W JOHN GWYNN AVE
    PEORIA, IL
    ZIP 61605
  • Phone: (309) 680-7600

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NPI Details

Punam Subhashchandra Trivede, APN is a family nurse practitioner in Peoria, IL with 8 years of experience. Punam Subhashchandra Trivede, APN NPI is 1790258473. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

711 W JOHN GWYNN AVE
PEORIA, IL
ZIP 61605-270
Phone: (309) 680-7600
Fax: (309) 671-2188

The NPI 1790258473 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Follow-up nursing facility visit per day, typically 15 minutes (HCPCS:99308)
  • Follow-up nursing facility visit per day, typically 25 minutes (HCPCS:99309)

The enumeration date for this NPI number is 1/6/2019 and was last updated on 7/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2200XNurse PractitionerAdult Health209018588ILLINOISNo
2363LF0000XNurse PractitionerFamily209018588ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1209018588MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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