Provider Demographics
NPI:1144602194
Name:VARNER, TREVOR BLAKE (LPN)
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:BLAKE
Last Name:VARNER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 416
Mailing Address - Street 2:BOX C
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09140
Mailing Address - Country:US
Mailing Address - Phone:314-467-5129
Mailing Address - Fax:
Practice Address - Street 1:CMR 416
Practice Address - Street 2:BOX C
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09140
Practice Address - Country:US
Practice Address - Phone:314-467-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217882164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse