Provider Demographics
NPI:1558512897
Name:WILLEY, TRENT (FNP)
Entity Type:Individual
Prefix:MR
First Name:TRENT
Middle Name:
Last Name:WILLEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 CANYON COVE GLN APT 29
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-0829
Mailing Address - Country:US
Mailing Address - Phone:801-644-3083
Mailing Address - Fax:
Practice Address - Street 1:1447 CANYON COVE GLN APT 29
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-0829
Practice Address - Country:US
Practice Address - Phone:801-644-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5319270-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily