Provider Demographics
NPI:1780007005
Name:SAVAGE, TRINA THEOLA (LPN)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:THEOLA
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 GLEN AVE
Mailing Address - Street 2:APARTMENT 303
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5144
Mailing Address - Country:US
Mailing Address - Phone:410-860-8244
Mailing Address - Fax:
Practice Address - Street 1:328 GLEN AVE
Practice Address - Street 2:APARTMENT 303
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5144
Practice Address - Country:US
Practice Address - Phone:410-860-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP44345164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse