Healthcare Provider Details

I. General information

NPI: 1558245506
Provider Name (Legal Business Name): SHANEA TREVINO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY STE 202
KALISPELL MT
59901-3127
US

IV. Provider business mailing address

6300 LOCARNO DR APT C
WHITEFISH MT
59937-3206
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8433
  • Fax: 406-756-6768
Mailing address:
  • Phone: 406-260-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number266043
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: