Provider Demographics
NPI:1114611969
Name:FENRICH, TREVOR C (EMT-B)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:C
Last Name:FENRICH
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4605
Mailing Address - Country:US
Mailing Address - Phone:920-233-0888
Mailing Address - Fax:
Practice Address - Street 1:621 EVANS ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4605
Practice Address - Country:US
Practice Address - Phone:920-233-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70118518207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services