Provider Demographics
NPI:1053125849
Name:PETER, TREVOR MICHAEL
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:MICHAEL
Last Name:PETER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 PIONEER GREENS DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9203
Mailing Address - Country:US
Mailing Address - Phone:402-202-8709
Mailing Address - Fax:
Practice Address - Street 1:1934 N 31ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1301
Practice Address - Country:US
Practice Address - Phone:402-202-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant