Healthcare Provider Details

I. General information

NPI: 1003385659
Provider Name (Legal Business Name): BALVENIA TREVINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BALVENIA SUE TREVION RN

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD STE 1140
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD STE 1140
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4351
  • Fax: 405-271-8665
Mailing address:
  • Phone: 405-271-4351
  • Fax: 405-271-8665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number128305
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number128305
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: