Provider Demographics
NPI:1871364943
Name:TREVIS, DONALD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:TREVIS
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 1:8325 MISTY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-9245
Mailing Address - Country:US
Mailing Address - Phone:513-238-5045
Mailing Address - Fax:
Practice Address - Street 1:8325 MISTY SHORE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-9245
Practice Address - Country:US
Practice Address - Phone:513-238-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant