Provider Demographics
NPI:1427276245
Name:BAJJOU, TREVA DENISE (LPN)
Entity type:Individual
Prefix:MISS
First Name:TREVA
Middle Name:DENISE
Last Name:BAJJOU
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 1:1390 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2767
Mailing Address - Country:US
Mailing Address - Phone:614-355-9306
Mailing Address - Fax:614-355-9310
Practice Address - Street 1:1390 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2767
Practice Address - Country:US
Practice Address - Phone:614-355-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-113092164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse