Healthcare Provider Details

I. General information

NPI: 1487077186
Provider Name (Legal Business Name): TRENTEN BASSETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MEMORIAL DR
PINEHURST NC
28374-8710
US

IV. Provider business mailing address

PO BOX 8500
PINEHURST NC
28374-8500
US

V. Phone/Fax

Practice location:
  • Phone: 910-715-1010
  • Fax: 910-715-1026
Mailing address:
  • Phone: 910-715-1233
  • Fax: 910-715-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12345
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: