Individual
JODY M TRENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1314 E 7TH ST STE 101, AUBURN, IN 46706-2533
(260) 925-3500
(260) 925-3195
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71003591A
IN
363LP0200X
Pediatric Nurse Practitioner
0050-03504
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704271240
LICENSE
MI
Enumeration date
09/27/2007
Last updated
06/04/2024
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