Healthcare Provider Details

I. General information

NPI: 1457343873
Provider Name (Legal Business Name): TRENT GERARD FRIEDEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HIGHLAND DR
MANY LA
71449-3718
US

IV. Provider business mailing address

126 FOX RUN DR.
NATCHITOCHES LA
71457-7881
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-5691
  • Fax:
Mailing address:
  • Phone: 318-481-9543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN071561 AP03252
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: