Provider Demographics
NPI:1538844576
Name:PRINGLE, TRISTA
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:PRINGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 AURORA AVE APT 130
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-9132
Mailing Address - Country:US
Mailing Address - Phone:608-320-4669
Mailing Address - Fax:
Practice Address - Street 1:5155 AURORA AVE APT 130
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-9132
Practice Address - Country:US
Practice Address - Phone:608-320-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty