Provider Demographics
NPI:1952390346
Name:TRYON, GENEVIEVE ELAINE (CRNP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ELAINE
Last Name:TRYON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 OAKWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5609
Mailing Address - Country:US
Mailing Address - Phone:330-550-1748
Mailing Address - Fax:330-841-9569
Practice Address - Street 1:3893 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4706
Practice Address - Country:US
Practice Address - Phone:330-856-4000
Practice Address - Fax:330-609-9910
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN163147COA1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTRNP18801Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OHS60828Medicare UPIN