Individual
TRISTA BODENSTADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1724 STATE ST, NEW ALBANY, IN 47150-4916
(502) 327-9100
Mailing address
9220 ROBIN RD, GEORGETOWN, IN 47122-8900
(502) 381-7592
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71012095A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100852640
—
KY
Enumeration date
01/08/2022
Last updated
10/12/2022
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