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General NPI Number Information
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NPI Number | 1619355443
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Entity Type | Organization
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Legal Business Name | TRISTIN DOUGLASS
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 2128 HOGE AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2130
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Country | US
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Telephone | 740-618-3068
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Fax |
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Provider Business Mailing Address
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Address Line | 2128 HOGE AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2130
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Country | US
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Telephone | 740-618-3068
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | TRISTIN D DOUGLASS
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Credential | LPN
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Telephone | 740-618-3068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | PN.145931-M-IV
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License Number State | OH
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