Provider Demographics
NPI:1598367617
Name:TRENT, WILLIE LEE
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:LEE
Last Name:TRENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2107
Mailing Address - Country:US
Mailing Address - Phone:304-309-5016
Mailing Address - Fax:
Practice Address - Street 1:211 11TH AVE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2107
Practice Address - Country:US
Practice Address - Phone:304-309-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant