Provider Demographics
NPI:1740306828
Name:MORGAN, TRENT MATTHEW (CRNA)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:MATTHEW
Last Name:MORGAN
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 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-476-5777
Mailing Address - Fax:208-476-5385
Practice Address - Street 1:301 CEDAR ST
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9029
Practice Address - Country:US
Practice Address - Phone:208-476-5777
Practice Address - Fax:208-476-5385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA380367500000X
IDRNA380A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA430075025OtherRAILROAD MEDICARE
ID430075025OtherRAIL ROAD MEDICARE
ID1740306828Medicaid
ID1740306828Medicaid
ID430075025OtherRAIL ROAD MEDICARE