Provider Demographics
NPI:1083760730
Name:TRIMBLE, WILLIAM KENNETH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KENNETH
Last Name:TRIMBLE
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 1:7307 EXTREME WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:VA
Mailing Address - Zip Code:23069-1631
Mailing Address - Country:US
Mailing Address - Phone:623-606-5439
Mailing Address - Fax:804-415-7317
Practice Address - Street 1:7307 EXTREME WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:VA
Practice Address - Zip Code:23069-1631
Practice Address - Country:US
Practice Address - Phone:623-606-5439
Practice Address - Fax:804-415-7137
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170056367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ493396Medicaid
AZ100702Medicare PIN
AZ493396Medicaid