Provider Demographics
NPI:1073367868
Name:TRIMBLE, LYNZEE RO'SHAY
Entity type:Individual
Prefix:
First Name:LYNZEE
Middle Name:RO'SHAY
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-5612
Mailing Address - Country:US
Mailing Address - Phone:918-208-5583
Mailing Address - Fax:
Practice Address - Street 1:1108 N WHEELER
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955
Practice Address - Country:US
Practice Address - Phone:918-775-5513
Practice Address - Fax:918-775-5526
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist