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General NPI Number Information
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NPI Number | 1851357966
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Entity Type | Individual
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Provider Name | TRINI LARS JEANICE II NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | MANNHEIM HEALTH CLINIC BENJAMIN FRANKLIN VILLAGE UNIT 29920
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City | APO
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State | AE
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Zip | 09267
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Country | DE
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Telephone | 496217301750
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Fax | 496217304665
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Provider Business Mailing Address
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Address Line | ATTN: CREDENTIALS OFFICE CMR 442
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City | APO
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State | AE
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Zip | A09042
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Country | DE
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Telephone | 4906221172274
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Fax | 4906221172941
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R116826
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License Number State | MD
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