Provider Demographics
NPI:1154313781
Name:MUNYER, TRENT (CRNA)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:MUNYER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3696 E SKY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7517
Mailing Address - Country:US
Mailing Address - Phone:208-818-5273
Mailing Address - Fax:
Practice Address - Street 1:3696 E SKY HARBOR DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-7517
Practice Address - Country:US
Practice Address - Phone:208-818-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 141026-2367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3521OtherCALIFORNIA BOARD OF REGISTERED NURSING
ID640AOtherIDAHO BOARD OF NURSING
MN130148900Medicaid