Provider Demographics
NPI:1609474220
Name:PROKOPIS, TREVOR
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:PROKOPIS
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 1:344 EAST 100 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-6973
Mailing Address - Country:US
Mailing Address - Phone:801-322-3222
Mailing Address - Fax:
Practice Address - Street 1:344 EAST 100 SOUTH
Practice Address - Street 2:
Practice Address - City:SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84129-6973
Practice Address - Country:US
Practice Address - Phone:801-322-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator