Individual
TRENT W EDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
4901 W MCDOWELL RD STE 110, PHOENIX, AZ 85035-4160
(623) 849-9088
(623) 849-9065
Mailing address
6622 N 91ST AVE STE 220, GLENDALE, AZ 85305-2569
(602) 759-6883
(602) 224-3315
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
233523
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087425
—
AZ
Enumeration date
12/21/2020
Last updated
05/20/2021
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