Provider Demographics
NPI:1891405411
Name:SEBRING, TREVOR (RN, NRP)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:SEBRING
Suffix:
Gender:M
Credentials:RN, NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:ADENA
Mailing Address - State:OH
Mailing Address - Zip Code:43901-0484
Mailing Address - Country:US
Mailing Address - Phone:740-827-5770
Mailing Address - Fax:
Practice Address - Street 1:18 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ADENA
Practice Address - State:OH
Practice Address - Zip Code:43901-7857
Practice Address - Country:US
Practice Address - Phone:740-827-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV100892163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH75832601Medicaid