Provider Demographics
NPI:1801816830
Name:BRISTOW, NANCY JANE (RN, BSN, CDE)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:RN, BSN, CDE
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:NICOLL
Other - Last Name:BRISTOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN, CDE
Mailing Address - Street 1:1325 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2158
Mailing Address - Country:US
Mailing Address - Phone:817-820-2890
Mailing Address - Fax:
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2158
Practice Address - Country:US
Practice Address - Phone:817-820-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255659163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator