Healthcare Provider Details

I. General information

NPI: 1659968261
Provider Name (Legal Business Name): EMILY DAWN TRENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5738 ROBERT C BYRD DR APT 111
MOUNT HOPE WV
25880-9408
US

IV. Provider business mailing address

PO BOX 902
BRADLEY WV
25818-0902
US

V. Phone/Fax

Practice location:
  • Phone: 304-860-9061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: