Provider Demographics
NPI:1295823011
Name:TRENT, JOEL IAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:IAN
Last Name:TRENT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:IAN
Other - Last Name:TRENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:10 WOODLAND ROAD
Practice Address - Street 2:ST. HELENA HOSPITAL
Practice Address - City:ST. HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574
Practice Address - Country:US
Practice Address - Phone:707-963-3611
Practice Address - Fax:707-967-5622
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531371367500000X
TX430340367500000X
CA2308367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA128939Medicare PIN