Healthcare Provider Details

I. General information

NPI: 1053671487
Provider Name (Legal Business Name): TREVOR J STYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 1731 510 CARIBOU CR
TISDALE SASKATCHEWAN
S0E1T0
CA

IV. Provider business mailing address

BOX 1731 510 CARIBOU CR
TISDALE SASKATCHEWAN
S0E1T0
CA

V. Phone/Fax

Practice location:
  • Phone: 306-873-4168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: