Provider Demographics
NPI:1134553548
Name:TRISTAN, LAURA ROCIO (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ROCIO
Last Name:TRISTAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PINOS ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2745
Mailing Address - Country:US
Mailing Address - Phone:715-550-7646
Mailing Address - Fax:
Practice Address - Street 1:1004 PINOS ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2745
Practice Address - Country:US
Practice Address - Phone:715-550-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI191064-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse