Provider Demographics
NPI:1659773661
Name:TRILL, KRISTIN CARRIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:CARRIE
Last Name:TRILL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:ZIOLEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 ELYRIA ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1031
Mailing Address - Country:US
Mailing Address - Phone:330-948-5533
Mailing Address - Fax:330-948-2726
Practice Address - Street 1:225 ELYRIA ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254
Practice Address - Country:US
Practice Address - Phone:330-948-9939
Practice Address - Fax:330-948-2263
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16569-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0111007Medicaid
OH1003849910OtherLODI COMMUNITY CARE CENTER TYPE 2 NPI #
OH3613031OtherLODI COMMUNITY HOSPITAL MEDICARE GROUP #
OH2396081OtherLODI COMMUNITY HOSPITAL MEDICAID GROUP #
OH1801807870OtherLODI COMMUNITY HOSPITAL TYPE 2 NPI #
OH0111007Medicaid