Provider Demographics
NPI:1073373619
Name:HAZEBROOK, TRISTAN WEBB
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:WEBB
Last Name:HAZEBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD DEPT OF PSYCHIATRY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1087
Mailing Address - Country:US
Mailing Address - Phone:336-716-4551
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD DEPT OF PSYCHIATRY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program