MEDICARE: TREVOR LEE RODENBAUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion		NE

General Provider Information

NPI Number	:	1780548339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR LEE RODENBAUGH

Provider Business Mailing Address
First Line	:	421 E 10TH ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-3923
Country	:	US
Telephone Number	:	308-380-6705
Fax Number	:	308-380-6705

Provider Business Practice Location Address
First Line	:	421 E 10TH ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-3923
Country	:	US
Telephone Number	:	308-380-6705
Fax Number	:	308-380-6705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ TREVOR LEE RODENBAUGH ” Practice Location

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