Provider Demographics
NPI:1396617122
Name:SCHAEFER, TRISTAN L (RN)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:L
Last Name:SCHAEFER
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 1:17220 E COUNTY ROAD 620 N
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:IN
Mailing Address - Zip Code:47246-9337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17220 E COUNTY ROAD 620 N
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:IN
Practice Address - Zip Code:47246-9337
Practice Address - Country:US
Practice Address - Phone:812-764-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28255489A163WG0000X, 163WI0500X, 163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy