Provider Demographics
NPI:1568719177
Name:NEY, TRISTA E
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:E
Last Name:NEY
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 1:32871 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-8329
Mailing Address - Country:US
Mailing Address - Phone:262-210-7583
Mailing Address - Fax:
Practice Address - Street 1:32871 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-8329
Practice Address - Country:US
Practice Address - Phone:262-210-7573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158893-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse