1467862458 NPI number — LORIE LILLIAN TRENTHAM APRN, CNP

Table of content: LORIE LILLIAN TRENTHAM APRN, CNP (NPI 1467862458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467862458 NPI number — LORIE LILLIAN TRENTHAM APRN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRENTHAM
Provider First Name:
LORIE
Provider Middle Name:
LILLIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNP
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:
1467862458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HULBERT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74441-0751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-772-3390
Provider Business Mailing Address Fax Number:
918-431-0203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E DOWNING ST
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-431-0202
Provider Business Practice Location Address Fax Number:
918-431-0203
Provider Enumeration Date:
04/30/2014

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: 363LF0000X , with the licence number:  71517 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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