Provider Demographics
NPI:1801032347
Name:ANTONELLI, TRINA LEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:LEANNE
Last Name:ANTONELLI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10160 CAVALRY CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4173
Mailing Address - Country:US
Mailing Address - Phone:810-845-1510
Mailing Address - Fax:
Practice Address - Street 1:10160 CAVALRY CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4173
Practice Address - Country:US
Practice Address - Phone:810-845-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242412367500000X
NVCRNA000414367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG003UOtherBCBS
FLP00772720OtherRAILROAD MEDICARE
FL001421100Medicaid
FLG003UOtherBCBS