Basic Information
| Provider Information | |||||||||
| NPI: | 1679892764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRICINELLA | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3345 S HARVARD AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187488111 | ||||||||
| FaxNumber: | 9187445284 | ||||||||
| Practice Location | |||||||||
| Address1: | 3345 S HARVARD AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187488111 | ||||||||
| FaxNumber: | 9187445284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2010 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 6063 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 738553 | 01 | OK | MEDICARE | OTHER | 200547390A | 05 | OK | MEDICAID |