Provider Demographics
NPI:1992523054
Name:BARE, TRISCELLA LYNN
Entity type:Individual
Prefix:
First Name:TRISCELLA
Middle Name:LYNN
Last Name:BARE
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 1:205 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-3298
Mailing Address - Country:US
Mailing Address - Phone:304-905-5496
Mailing Address - Fax:
Practice Address - Street 1:205 FULLER RD
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-3298
Practice Address - Country:US
Practice Address - Phone:304-905-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant