Provider Demographics
NPI:1922534056
Name:BLACKWILL, TRENT COLIN (CRNA, DNAP)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:COLIN
Last Name:BLACKWILL
Suffix:
Gender:M
Credentials:CRNA, DNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-2227
Mailing Address - Country:US
Mailing Address - Phone:509-659-1200
Mailing Address - Fax:
Practice Address - Street 1:903 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-2227
Practice Address - Country:US
Practice Address - Phone:509-659-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13119182367500000X
KS43-557501-011367500000X
WAAP61555786367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
14033145OtherCAQH