Provider Demographics
NPI:1598535874
Name:BRISTER, ROMA LYNDA (RN)
Entity Type:Individual
Prefix:
First Name:ROMA
Middle Name:LYNDA
Last Name:BRISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROMA
Other - Middle Name:LYNDA
Other - Last Name:BRISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3151 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4918
Mailing Address - Country:US
Mailing Address - Phone:805-765-0946
Mailing Address - Fax:
Practice Address - Street 1:3151 TRINITY DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4918
Practice Address - Country:US
Practice Address - Phone:805-765-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455664163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice