Provider Demographics
NPI:1538677950
Name:MOCK, TREVOR DAVID (CRNA)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:DAVID
Last Name:MOCK
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 1:1121 LAKESHORE DR W
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-9723
Mailing Address - Country:US
Mailing Address - Phone:614-824-0850
Mailing Address - Fax:
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1613
Practice Address - Country:US
Practice Address - Phone:614-824-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.019621367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered