Healthcare Provider Details

I. General information

NPI: 1104173806
Provider Name (Legal Business Name): MR. TRENTON ANDREW REED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15374 COUNTY ROAD T
NAPOLEON OH
43545-9758
US

IV. Provider business mailing address

15374 COUNTY ROAD T
NAPOLEON OH
43545-9758
US

V. Phone/Fax

Practice location:
  • Phone: 419-966-0841
  • Fax:
Mailing address:
  • Phone: 419-966-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.13993
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number723803
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberCOA.13993-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: