Provider Demographics
NPI:1124052485
Name:LAZANIS, TRINITY RACHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TRINITY
Middle Name:RACHELLE
Last Name:LAZANIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 FRY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2723
Mailing Address - Country:US
Mailing Address - Phone:440-813-1709
Mailing Address - Fax:
Practice Address - Street 1:6002 FRY RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2723
Practice Address - Country:US
Practice Address - Phone:440-813-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113519164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2527671Medicaid