Provider Demographics
NPI:1447008073
Name:O'NEAL, TREVOR (RN)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NW WALL ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2608
Mailing Address - Country:US
Mailing Address - Phone:541-355-6937
Mailing Address - Fax:
Practice Address - Street 1:20805 COOLEY RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8076
Practice Address - Country:US
Practice Address - Phone:541-355-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200740303163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool