Provider Demographics
NPI:1467295378
Name:LIND, TRIXY A
Entity type:Individual
Prefix:
First Name:TRIXY
Middle Name:A
Last Name:LIND
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:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:ID
Mailing Address - Zip Code:83232-0114
Mailing Address - Country:US
Mailing Address - Phone:208-221-4337
Mailing Address - Fax:
Practice Address - Street 1:4375 W 1200 N
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:ID
Practice Address - Zip Code:83232-5100
Practice Address - Country:US
Practice Address - Phone:208-221-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care