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Individual
TRISTA MICHELLE ANDERSON
Active
Individual
TRISTA MICHELLE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71004062A
IN
363LW0102X
Women's Health Nurse Practitioner
28168862A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201082150
—
IN
01
—
P01316451
MEDICARE RR PTAN
IN
Enumeration date
05/22/2012
Last updated
04/08/2015
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