Provider Demographics
NPI:1689480691
Name:TREVINO, NICOLE BRONWYN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRONWYN
Last Name:TREVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 S 267TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6131
Mailing Address - Country:US
Mailing Address - Phone:918-764-6679
Mailing Address - Fax:
Practice Address - Street 1:8900 S 267TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-6131
Practice Address - Country:US
Practice Address - Phone:918-764-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program