Shaw, Trent E
Shaw, Trent E is an individual health care provider with primary practice located at 72 E Main St , Rexburg ID 83440-1926. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Shaw, Trent E can be contacted via phone (208) 359-1770.Contact Information
Primary practice address
72 E Main St
Rexburg ID 83440-1926
Phone: (208) 359-1770
Fax: (208) 359-1780
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA-308 | Idaho |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA-308 | Idaho |
Profile Details
| NPI number | 1366488926 |
|---|---|
| LBN Legal business name | Shaw, Trent E |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2006 |
| Last updated | Sep 30th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366488926 | NPPES |
| Idaho | MEDICAID | 806887500 |
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