Provider Demographics
NPI:1639764632
Name:TREVINO, LYNN ANNETTE
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANNETTE
Last Name:TREVINO
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 692
Mailing Address - Street 2:
Mailing Address - City:KILLDEER
Mailing Address - State:ND
Mailing Address - Zip Code:58640-0692
Mailing Address - Country:US
Mailing Address - Phone:701-260-1753
Mailing Address - Fax:
Practice Address - Street 1:39 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:KILLDEER
Practice Address - State:ND
Practice Address - Zip Code:58640
Practice Address - Country:US
Practice Address - Phone:701-260-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant