Provider Demographics
NPI:1144374232
Name:LENGL, TRENT I (PA-C)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:I
Last Name:LENGL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 N TIMBER RIM DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1668
Mailing Address - Country:US
Mailing Address - Phone:509-921-6804
Mailing Address - Fax:509-455-9227
Practice Address - Street 1:820 S MCCLELLAN ST
Practice Address - Street 2:SUITE 426
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2457
Practice Address - Country:US
Practice Address - Phone:509-456-8444
Practice Address - Fax:509-455-9227
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1030170Medicaid
WAAB28425Medicare UPIN