Provider Demographics
NPI:1700363348
Name:BRISTOW, TEIRZA D (ARNP)
Entity Type:Individual
Prefix:
First Name:TEIRZA
Middle Name:D
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JACOBS GULCH RD
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2023
Mailing Address - Country:US
Mailing Address - Phone:208-784-4612
Mailing Address - Fax:208-783-1342
Practice Address - Street 1:25 JACOBS GULCH RD
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2023
Practice Address - Country:US
Practice Address - Phone:208-784-4612
Practice Address - Fax:208-783-1342
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59228363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care