Provider Demographics
NPI:1386912798
Name:DOUGLASS, TRISTIAN DANIELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:TRISTIAN
Middle Name:DANIELLE
Last Name:DOUGLASS
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 1:2128 HOGE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2130
Mailing Address - Country:US
Mailing Address - Phone:740-618-3068
Mailing Address - Fax:
Practice Address - Street 1:2128 HOGE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2130
Practice Address - Country:US
Practice Address - Phone:740-618-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.145931-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse