Provider Demographics
NPI:1871959908
Name:TRENT, CHANTAL (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:TRENT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 WOODFIELD CROSSING BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7315
Mailing Address - Country:US
Mailing Address - Phone:260-489-7369
Mailing Address - Fax:
Practice Address - Street 1:8425 WOODFIELD CROSSING BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7315
Practice Address - Country:US
Practice Address - Phone:317-554-0555
Practice Address - Fax:866-725-5351
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28186664A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily