Provider Demographics
NPI:1851357966
Name:JEANICE, TRINI LARS II (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:TRINI
Middle Name:LARS
Last Name:JEANICE
Suffix:II
Gender:M
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:ATTN: CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:A09042
Mailing Address - Country:DE
Mailing Address - Phone:490622-117-2274
Mailing Address - Fax:490622-117-2941
Practice Address - Street 1:MANNHEIM HEALTH CLINIC
Practice Address - Street 2:BENJAMIN FRANKLIN VILLAGE UNIT 29920
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09267
Practice Address - Country:DE
Practice Address - Phone:49621-730-1750
Practice Address - Fax:49621-730-4665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MDR116826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily