Provider Demographics
NPI:1477238376
Name:EZELL, TRISHA LYNNETTE (RN)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNNETTE
Last Name:EZELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:L
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:22 GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-2043
Mailing Address - Country:US
Mailing Address - Phone:417-296-2072
Mailing Address - Fax:
Practice Address - Street 1:22 GLORIA DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-2043
Practice Address - Country:US
Practice Address - Phone:417-296-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015032408163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse