Provider Demographics
NPI:1699535310
Name:TRENT POWE, SHANALYNN JOSEFINA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SHANALYNN
Middle Name:JOSEFINA
Last Name:TRENT POWE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6406
Mailing Address - Country:US
Mailing Address - Phone:845-239-8063
Mailing Address - Fax:
Practice Address - Street 1:31 MILLS AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6406
Practice Address - Country:US
Practice Address - Phone:845-239-8063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688523163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy