Provider Demographics
NPI:1982911640
Name:HOFSCHULTE, TRISTA MARIE (CNIM)
Entity Type:Individual
Prefix:MISS
First Name:TRISTA
Middle Name:MARIE
Last Name:HOFSCHULTE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 E BATES DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-6010
Mailing Address - Country:US
Mailing Address - Phone:970-846-0127
Mailing Address - Fax:720-747-5837
Practice Address - Street 1:1325 BOWSTRING RD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8580
Practice Address - Country:US
Practice Address - Phone:970-846-0127
Practice Address - Fax:719-487-2689
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1845246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1845OtherAMERICAN BOARD OF REGISTRATION OF ELECTROENCEPHALOGRAPHIC AND EVOKED POTENTIAL..