Individual
TRISTA MICHELLE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1550 E. COUNTY LINE ROAD, SUITE 300, INDIANAPOLIS, IN 46227-0990
(317) 497-2300
Mailing address
6626 E 75TH ST, 500, INDIANAPOLIS, IN 46250-2805
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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