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General NPI Number Information
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NPI Number | 1851367759
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Entity Type | Individual
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Provider Name | TRINETTA DAWN MASTERNICK D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 964 N MARKET ST
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City | LISBON
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State | OH
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Zip | 44432-9363
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Country | US
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Telephone | 330-424-1468
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 464
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City | LISBON
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State | OH
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Zip | 44432-0464
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Country | US
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Telephone | 330-424-1468
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Fax |
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 34.007852
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.007852
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License Number State | OH
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