Provider Demographics
NPI:1285351213
Name:TREXLER, SHARON L
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:TREXLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62890-2020
Mailing Address - Country:US
Mailing Address - Phone:618-513-8307
Mailing Address - Fax:
Practice Address - Street 1:170 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:THOMPSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62890-2020
Practice Address - Country:US
Practice Address - Phone:618-513-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3234249B347C00000X
2472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT624-7927-0776OtherDRIVER'S LICENSE