Provider Demographics
NPI:1891402863
Name:CHURCHWELL, TREVA M (RN WON)
Entity Type:Individual
Prefix:MRS
First Name:TREVA
Middle Name:M
Last Name:CHURCHWELL
Suffix:
Gender:F
Credentials:RN WON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 HORSESHOE LOOP
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-9020
Mailing Address - Country:US
Mailing Address - Phone:501-580-1450
Mailing Address - Fax:501-500-5897
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3353
Practice Address - Country:US
Practice Address - Phone:501-776-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR85437163W00000X, 163WH0200X, 163WH1000X, 163WX1500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care