1053301069 NPI number — MRS. ERIN NICOLE TRENT PA-C

Table of content: MRS. ERIN NICOLE TRENT PA-C (NPI 1053301069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053301069 NPI number — MRS. ERIN NICOLE TRENT PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRENT
Provider First Name:
ERIN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053301069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2864 WOODRUFF ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LIBERTY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-570-3108
Provider Business Mailing Address Fax Number:
910-907-4222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2864 WOODRUFF ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-570-3108
Provider Business Practice Location Address Fax Number:
910-907-4222
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  103722 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 103722 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162GG . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13268762 . This is a "PHCS/MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1375522 . This is a "WELLPATH/COVENTRY/DR'S DIRECT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4042423 . This is a "COVENTRY NATIONAL PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: FH4001590 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1053301069 . This is a "GEHA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3119138 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1053301069 . This is a "HEALTHNET FEDERAL SERVICES/TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1053301069 . This is a "HEALTHSMART" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 257641 . This is a "MEDCOST LLC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4111984 . This is a "CIGNA/GREATWEST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9209980 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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