Provider Demographics
NPI:1659305134
Name:TOMLINSON, TREVOR KOEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:KOEL
Last Name:TOMLINSON
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 1:696 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1614
Mailing Address - Country:US
Mailing Address - Phone:801-830-8738
Mailing Address - Fax:
Practice Address - Street 1:320 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6060
Practice Address - Country:US
Practice Address - Phone:801-830-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT266865-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered