Healthcare Provider Details

I. General information

NPI: 1851367759
Provider Name (Legal Business Name): TRINETTA DAWN MASTERNICK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 N MARKET ST
LISBON OH
44432-9363
US

IV. Provider business mailing address

PO BOX 464
LISBON OH
44432-0464
US

V. Phone/Fax

Practice location:
  • Phone: 330-424-1468
  • Fax:
Mailing address:
  • Phone: 330-424-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number34.007852
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.007852
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: