Healthcare Provider Details

I. General information

NPI: 1215842687
Provider Name (Legal Business Name): DANIELLE TREVINO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 HARDING STREET
DEFIANCE OH
43512
US

IV. Provider business mailing address

1111 HOPKINS ST # SR
DEFIANCE OH
43512-2424
US

V. Phone/Fax

Practice location:
  • Phone: 419-455-0063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.163498.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: