Edstrom, Trent W
Edstrom, Trent W is an individual health care provider with primary practice located at 4901 W Mcdowell Rd Ste 110 , Phoenix AZ 85035-4160. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as his primary health care specialty. Edstrom, Trent W can be contacted via phone (623) 849-9088.Contact Information
Primary practice address
4901 W Mcdowell Rd Ste 110
Phoenix AZ 85035-4160
Phone: (623) 849-9088
Fax: (623) 849-9065
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Primary Care | 363LP2300X | 233523 | Arizona |
Profile Details
| NPI number | 1558957811 |
|---|---|
| LBN Legal business name | Edstrom, Trent W |
| Credentials | NURSE PRACTITIONER |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 21st, 2020 |
| Last updated | May 20th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558957811 | NPPES |
| Arizona | MEDICAID | 087425 |
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