MEDICARE: MR. TREVOR ANTONIO CONNELL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	561117	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8138UG	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1700842242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TREVOR ANTONIO CONNELL CRNA

Provider Business Mailing Address
First Line	:	P.O. BOX 2403
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75106
Country	:	US
Telephone Number	:	832-277-8108
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 ELISE ST.
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104
Country	:	US
Telephone Number	:	832-277-8108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	03/11/2014

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