Provider Demographics
NPI:1629832795
Name:BARSTOW, TRISTA
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:BARSTOW
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HOLDINGFORD
Mailing Address - State:MN
Mailing Address - Zip Code:56340-0010
Mailing Address - Country:US
Mailing Address - Phone:218-255-1563
Mailing Address - Fax:320-746-9912
Practice Address - Street 1:231 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLDINGFORD
Practice Address - State:MN
Practice Address - Zip Code:56340-9513
Practice Address - Country:US
Practice Address - Phone:320-828-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN415436310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility