Provider Demographics
NPI:1568229185
Name:RIST, COLEEN
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:RIST
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 1:1123 7TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2019
Mailing Address - Country:US
Mailing Address - Phone:701-720-4916
Mailing Address - Fax:
Practice Address - Street 1:1123 7TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2019
Practice Address - Country:US
Practice Address - Phone:701-720-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator