Provider Demographics
NPI:1659601060
Name:TRIMBLE, SHAWN DEL (LPN)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DEL
Last Name:TRIMBLE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 COVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-2811
Mailing Address - Country:US
Mailing Address - Phone:937-541-1916
Mailing Address - Fax:
Practice Address - Street 1:1234 COVINGTON AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2811
Practice Address - Country:US
Practice Address - Phone:937-541-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147325-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse