Provider Demographics
NPI:1164191342
Name:ELAM, TRENT (RN)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:ELAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 NEW MEXICO DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-4774
Mailing Address - Country:US
Mailing Address - Phone:937-344-1048
Mailing Address - Fax:
Practice Address - Street 1:1169 NEW MEXICO DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4774
Practice Address - Country:US
Practice Address - Phone:937-344-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH473776163WE0003X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WE0003XNursing Service ProvidersRegistered NurseEmergency