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NPI Code Detail

MEDICARE: TRENT H NOURSE PA-C, MPAS

MEDICARE: TRENT H NOURSE PA-C, MPAS
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
1363A00000XPhysician Assistant50.001406RXOH

General Provider Information

NPI Number : 1821091455
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRENT H NOURSE PA-C, MPAS
Provider Business Mailing Address
First Line : 7774 DAYTON SPRINGFIELD RD
Second Line :
City : FAIRBORN
State : OH
Zip : 45324-1957
Country : US
Telephone Number : 937-864-7363
Fax Number : 937-864-5895
Provider Business Practice Location Address
First Line : 7774 DAYTON SPRINGFIELD RD
Second Line :
City : FAIRBORN
State : OH
Zip : 45324-1957
Country : US
Telephone Number : 937-864-7363
Fax Number : 937-864-5895
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 10/18/2025

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Directions to “ TRENT H NOURSE PA-C, MPAS” Practice Location

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