Provider Demographics
NPI:1043412307
Name:DEBBIE BRISTOL APN LLC
Entity Type:Organization
Organization Name:DEBBIE BRISTOL APN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:775-777-1510
Mailing Address - Street 1:475 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3852
Mailing Address - Country:US
Mailing Address - Phone:775-777-1510
Mailing Address - Fax:775-777-8783
Practice Address - Street 1:475 8TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3852
Practice Address - Country:US
Practice Address - Phone:775-777-1510
Practice Address - Fax:775-777-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS33303Medicare UPIN
NV103937Medicare PIN