Provider Demographics
NPI:1518484864
Name:TRENT, MIRANDA G
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:G
Last Name:TRENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4593
Mailing Address - Country:US
Mailing Address - Phone:434-984-6220
Mailing Address - Fax:434-984-5517
Practice Address - Street 1:233 4TH ST NW
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4593
Practice Address - Country:US
Practice Address - Phone:434-984-6220
Practice Address - Fax:434-984-5517
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner