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General NPI Number Information
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NPI Number | 1447960604
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Entity Type | Individual
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Provider Name | MICHELLE TREVINO FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 148 S BOLINGBROOK DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2852
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Country | US
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Telephone | 630-914-5373
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Fax |
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Provider Business Mailing Address
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Address Line | 25613 W CERENA CIR
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City | PLAINFIELD
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State | IL
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Zip | 60586-6825
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Country | US
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Telephone | 320-455-2598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.026569
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License Number State | IL
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