Provider Demographics
NPI:1316913726
Name:REES, TRENT ALLEN (PAC)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:ALLEN
Last Name:REES
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W 22ND ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4304
Mailing Address - Country:US
Mailing Address - Phone:765-643-0766
Mailing Address - Fax:765-640-2353
Practice Address - Street 1:141 W 22ND ST
Practice Address - Street 2:SUITE 213
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4304
Practice Address - Country:US
Practice Address - Phone:765-643-0766
Practice Address - Fax:765-640-2353
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000748A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ25919Medicare UPIN
IN465710EMedicare PIN